Renewable Energy Systems Intake Survey

1.First Name:(Required.)

2.Last Name:(Required.)

3.Physical Address of Possible Renewable Energy Project:(Required.)

Address

City

State

Zip

4.Mailing Address (if different from Physical Address)

Address 1

Address 2

City

State

Zip

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

Day:

Evening:

6.E-mail Address:(Required.)

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

8.What are your energy goals?

Very important

Important

Somewhat Important

Not Important

Spend less money on my energy bills

Very important

Important

Somewhat Important

Not Important

Stop wasting energy - identify inefficient appliances, air seal and insulate my house

Very important

Important

Somewhat Important

Not Important

Make my home safer - ensure combustion appliances are working properly, check indoor air quality

Very important

Important

Somewhat Important

Not Important

Make my home more comfortable - air seal and insulate my house, stop air leaks and drafts, install thermal window inserts

Very important

Important

Somewhat Important

Not Important

Be self-sufficient - make the energy I need

Very important

Important

Somewhat Important

Not Important

Reduce my dependence on fossil fuels - find alternatives to oil, propane, and natural gas

Very important

Important

Somewhat Important

Not Important

Keep my home warm, cook, and have lights and my fridge on during a power outage

Very important

Important

Somewhat Important

Not Important

Support my local economy - support local businesses and local jobs

Very important

Important

Somewhat Important

Not Important

Ensure everyone in my community has access to clean energy

Very important

Important

Somewhat Important

Not Important

Renewable Energy Systems Intake

Contact Info & Interests