Energy Audit
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1. Application
1
. Business Name
Business Name
2
. How many offices do you have?
How many offices do you have?
3
. Main Office Address
Main Office Address
4
. City, State, Zip
City, State, Zip
5
. Contact Name, Position
Contact Name, Position
6
. Telephone Number
Telephone Number
7
. Email Address
Email Address
8
. What is the total sq. footage of the facility being assessed?
What is the total sq. footage of the facility being assessed?
9
. What days / hours of the week does your facility operate?
What days / hours of the week does your facility operate?
10
. On average, how many employees are in the facility at a given time?
On average, how many employees are in the facility at a given time?
11
. On average, how many customers /clients are in the facility?
On average, how many customers /clients are in the facility?
12
. What types of energy / fuel does your facility use?
What types of energy / fuel does your facility use?
Electricity
Gas
Oil
Propane
Biofuels
Other
I don't know
If other, please list the other type(s) of fuel that your facility uses here:
13
. What is your annual electricity bill total ($)?
What is your annual electricity bill total ($)?
14
. During a peak summer month (i.e. August), what is your average monthly electricity bill ($)?
During a peak summer month (i.e. August), what is your average monthly electricity bill ($)?
15
. During a peak winter month (i.e. January), what is your average monthly electricity bill ($)?
During a peak winter month (i.e. January), what is your average monthly electricity bill ($)?
16
. Who is your gas provider?
Who is your gas provider?
ConEdison
National Grid
A 3rd party Energy Service Company (ESCO)?
17
. If 3rd party Esco, what is the name of the ESCO? What month/year did you sign up with the ESCO?
If 3rd party Esco, what is the name of the ESCO? What month/year did you sign up with the ESCO?
18
. What are your annual gas and/or oil bill totals ($)?
What are your annual gas and/or oil bill totals ($)?
19
. During a peak summer month (i.e. August), what is your average monthly gas and/or oil bill ($)?
During a peak summer month (i.e. August), what is your average monthly gas and/or oil bill ($)?
20
. During a peak winter month (i.e. January), what is your average monthly gas and/or oil bill ($)?
During a peak winter month (i.e. January), what is your average monthly gas and/or oil bill ($)?
21
. What is your annual water bill total ($)?
What is your annual water bill total ($)?
22
. During the summer, what is your average monthly water bill (i.e. August) ($)?
During the summer, what is your average monthly water bill (i.e. August) ($)?
23
. During the winter, what is your average monthly water bill (i.e. January) ($)?
During the winter, what is your average monthly water bill (i.e. January) ($)?
24
. Do you know about the following incentive programs?
Do you know about the following incentive programs?
NYSERDA Energy Audit Program
NYSERDA Existing Facilities Program
NYSERDA Energy $mart Loan Program
DEP Free Water Audit
DEP Free Water Conservation Kits
Coned Lighting Upgrade Programs
ConEd Free Programmable Thermostat Program
If not, please specify which you would like to learn more about.
25
. Have you ever had a professional energy efficiency assessment of your facility and/or would you be interested in one?
Have you ever had a professional energy efficiency assessment of your facility and/or would you be interested in one?
Yes (and I would like another one)
Yes (and no thanks)
No (but I would like one)
No (and no thanks)
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