2022-2024 Energy Pledge - CARE and Direct Install Agencies

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* 1. First Name

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* 2. Last Name

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* 3. Please enter participant address. (ONLY REQUIRED FOR NON-XCEL UTILITY CUSTOMERS)

Address

Address 2

City/Town

ZIP/Postal Code

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* 4. Does the participant own or rent the property? (ONLY REQUIRED FOR NON-XCEL UTILITY CUSTOMERS)

Own

Rent

Other (please specify)

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* 5. Property Type (ONLY REQUIRED FOR NON-XCEL UTILITY CUSTOMERS)

Apartment

House

Mobile Home

Other (please specify)

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* 6. Who provides energy for the participant (check all that apply)?

Xcel gas

Xcel electric

PRPA electric

Black Hills gas

City of Gunnison Electric

GCEA

Holy Cross

LPEA

SMPA

YVEA

Other (please specify)

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* 7. Please provide account numbers for all non-Xcel customer utilities (if applicable)

Non-Xcel Utility 1 Name & Type

Non-Xcel Utility 1 Account Number

Non-Xcel Utility 2 Name & Type

Non-Xcel Utility 2 Account Number

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* 8. Preferred Language

English

Spanish

Other (please specify)

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* 9. Zip Code

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* 10. Which One-Time Action will you take to lower your gas or electric bill? (If appointment is in-person, have them write these actions on their magnet).

Set water heater to 120F

Set refrigerator temperature between 36-39F

Set sleep mode on electronics

Other (please specify)

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* 11. Which Everyday Action will you take to lower your gas or electric bill? (If appointment is in-person, have them write these actions on their magnet).

Adjust thermostat when away & asleep

Wash clothes in cold water

Unplug appliances when not in use

Other (please specify)

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* 12. Do you commit to checking your energy use each month to understand how your actions are affecting your gas or electric bills?

Yes

Other (please specify)

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* 13. How do you typically view your energy bill?

Mailed paper bill

Online

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* 14. Type of appointment

In-person

Remote with email

Remote without email

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* 15. Energy Outreach Colorado (the non-profit that funds this program) would like to reach out to you to offer additional tools, support and seasonal reminders. Please provide e-mail address and mobile number that receives texts (if any). Provide mailing address for those without email or mobile phone.

2022-2024 Energy Pledge - CARE and Direct Install Agencies

Question Title

* 1. First Name

Question Title

* 2. Last Name

Question Title

* 3. Please enter participant address. (ONLY REQUIRED FOR NON-XCEL UTILITY CUSTOMERS)

Question Title

* 4. Does the participant own or rent the property? (ONLY REQUIRED FOR NON-XCEL UTILITY CUSTOMERS)

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* 5. Property Type (ONLY REQUIRED FOR NON-XCEL UTILITY CUSTOMERS)

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* 6. Who provides energy for the participant (check all that apply)?

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* 7. Please provide account numbers for all non-Xcel customer utilities (if applicable)

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* 8. Preferred Language

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* 9. Zip Code

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* 10. Which One-Time Action will you take to lower your gas or electric bill? (If appointment is in-person, have them write these actions on their magnet).

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* 11. Which Everyday Action will you take to lower your gas or electric bill? (If appointment is in-person, have them write these actions on their magnet).

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* 12. Do you commit to checking your energy use each month to understand how your actions are affecting your gas or electric bills?

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* 13. How do you typically view your energy bill?

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* 14. Type of appointment

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* 16. Additional comments from appointment

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* 17. Organization Performing Education