Energy Awareness Survey
Exit this survey
Brief
City West is commited to doing anything we can to helping you lower your energy usage and save you money. We want to see how switched on you are so we can provide any help to you.
1
. Customers Information
Customers Information
Name:
Address 1:
Address 2:
ZIP/Postal Code:
Email Address:
Phone Number:
2
. Gender:
Gender:
Male
Female
3
. Age:
Age:
16-19
20-24
25-34
35-44
45-54
55-59
60-64
65-74
75-84
85+
Prefer not to say
4
. How many people live in your household?
How many people live in your household?
1
2
3
4
5
6+
5
. What type of property do you live in?
What type of property do you live in?
Flat
Mid Terrace
Semi Detached
Detached
Bungalo
Sheltered Scheme
Powered by
SurveyMonkey
Create your own
free online survey
now!
Javascript is required for this site to function, please enable.