Renewable Energy Systems Intake

Contact Info & Interests

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* 1. First Name:

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* 2. Last Name:

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* 3. Physical Address of Possible Renewable Energy Project:

Address

City

State

Zip

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* 4. Mailing Address (if different from Physical Address)

Address 1

Address 2

City

State

Zip

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* 5. Best phone number(s) you can be reached at:

Day:

Evening:

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* 6. E-mail Address:

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* 7. How did you hear about Co-op Power?

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* 8. What are your energy goals?

	Very important	Important	Somewhat Important	Not Important
Spend less money on my energy bills	Spend less money on my energy bills Very important	Spend less money on my energy bills Important	Spend less money on my energy bills Somewhat Important	Spend less money on my energy bills Not Important
Stop wasting energy - identify inefficient appliances, air seal and insulate my house	Stop wasting energy - identify inefficient appliances, air seal and insulate my house Very important	Stop wasting energy - identify inefficient appliances, air seal and insulate my house Important	Stop wasting energy - identify inefficient appliances, air seal and insulate my house Somewhat Important	Stop wasting energy - identify inefficient appliances, air seal and insulate my house Not Important
Make my home safer - ensure combustion appliances are working properly, check indoor air quality	Make my home safer - ensure combustion appliances are working properly, check indoor air quality Very important	Make my home safer - ensure combustion appliances are working properly, check indoor air quality Important	Make my home safer - ensure combustion appliances are working properly, check indoor air quality Somewhat Important	Make my home safer - ensure combustion appliances are working properly, check indoor air quality Not Important
Make my home more comfortable - air seal and insulate my house, stop air leaks and drafts, install thermal window inserts	Make my home more comfortable - air seal and insulate my house, stop air leaks and drafts, install thermal window inserts Very important	Make my home more comfortable - air seal and insulate my house, stop air leaks and drafts, install thermal window inserts Important	Make my home more comfortable - air seal and insulate my house, stop air leaks and drafts, install thermal window inserts Somewhat Important	Make my home more comfortable - air seal and insulate my house, stop air leaks and drafts, install thermal window inserts Not Important
Be self-sufficient - make the energy I need	Be self-sufficient - make the energy I need Very important	Be self-sufficient - make the energy I need Important	Be self-sufficient - make the energy I need Somewhat Important	Be self-sufficient - make the energy I need Not Important
Reduce my dependence on fossil fuels - find alternatives to oil, propane, and natural gas	Reduce my dependence on fossil fuels - find alternatives to oil, propane, and natural gas Very important	Reduce my dependence on fossil fuels - find alternatives to oil, propane, and natural gas Important	Reduce my dependence on fossil fuels - find alternatives to oil, propane, and natural gas Somewhat Important	Reduce my dependence on fossil fuels - find alternatives to oil, propane, and natural gas Not Important
Keep my home warm, cook, and have lights and my fridge on during a power outage	Keep my home warm, cook, and have lights and my fridge on during a power outage Very important	Keep my home warm, cook, and have lights and my fridge on during a power outage Important	Keep my home warm, cook, and have lights and my fridge on during a power outage Somewhat Important	Keep my home warm, cook, and have lights and my fridge on during a power outage Not Important
Support my local economy - support local businesses and local jobs	Support my local economy - support local businesses and local jobs Very important	Support my local economy - support local businesses and local jobs Important	Support my local economy - support local businesses and local jobs Somewhat Important	Support my local economy - support local businesses and local jobs Not Important
Ensure everyone in my community has access to clean energy	Ensure everyone in my community has access to clean energy Very important	Ensure everyone in my community has access to clean energy Important	Ensure everyone in my community has access to clean energy Somewhat Important	Ensure everyone in my community has access to clean energy Not Important

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* 9. What kind of renewable energy system(s) you are interested in:

	Already installed	Would consider installing	I'd like more info
Solar Electric (PV)	Solar Electric (PV) Already installed	Solar Electric (PV) Would consider installing	Solar Electric (PV) I'd like more info
Solar Hot Water for my home's hot water	Solar Hot Water for my home's hot water Already installed	Solar Hot Water for my home's hot water Would consider installing	Solar Hot Water for my home's hot water I'd like more info
Solar Hot Water radiant heating	Solar Hot Water radiant heating Already installed	Solar Hot Water radiant heating Would consider installing	Solar Hot Water radiant heating I'd like more info
Community-Owned Shared Solar	Community-Owned Shared Solar Already installed	Community-Owned Shared Solar Would consider installing	Community-Owned Shared Solar I'd like more info
MiniSplit/Heat Pump -- High Efficiency Electric Air Heat and Cooling	MiniSplit/Heat Pump -- High Efficiency Electric Air Heat and Cooling Already installed	MiniSplit/Heat Pump -- High Efficiency Electric Air Heat and Cooling Would consider installing	MiniSplit/Heat Pump -- High Efficiency Electric Air Heat and Cooling I'd like more info
Solar Hot Air	Solar Hot Air Already installed	Solar Hot Air Would consider installing	Solar Hot Air I'd like more info
Heat Pump Water Heater (Electric)	Heat Pump Water Heater (Electric) Already installed	Heat Pump Water Heater (Electric) Would consider installing	Heat Pump Water Heater (Electric) I'd like more info
On Demand Water Heater (Electric or Propane)	On Demand Water Heater (Electric or Propane) Already installed	On Demand Water Heater (Electric or Propane) Would consider installing	On Demand Water Heater (Electric or Propane) I'd like more info
Wood or Pellet Heat	Wood or Pellet Heat Already installed	Wood or Pellet Heat Would consider installing	Wood or Pellet Heat I'd like more info
Geothermal	Geothermal Already installed	Geothermal Would consider installing	Geothermal I'd like more info
Battery Storage	Battery Storage Already installed	Battery Storage Would consider installing	Battery Storage I'd like more info

Other (please specify)