ENERGY FIT REGISTRATION FORM Energy FIT is Pelican Energy TCI’s FREE Home Energy Assessment, designed to help eligible homeowners better understand how their homes use electricity, identify potential energy waste, and receive practical tips to help them save. Complete this form to register your interest in the Energy FIT Program. Question Title * 1. ELIGIBILITY & PROPERTY INFORMATIONPlease answer the following questions to confirm your eligibility. (Required.) I am the homeowner and live in the home being assessed. I have an active Pelican Energy TCI residential account. I have occupied this home for at least one full year. Question Title * 2. CUSTOMER INFORMATION (Required.) Question Title * 3. Select Your Island (Required.) Providenciales Grand Turk South Caicos North Caicos Middle Caicos Salt Cay Question Title * 4. PROPERTY DETAILS (Required.) Question Title * 5. Number of Persons Residing In The Home (Required.) Question Title * 6. TYPE OF DWELLING (Required.) Single-Family Home (detached house) Townhouse Duplex Condominium Multi-Family Building (3 or more units) Other (please specify) Question Title * 7. TERMS & CONDITIONSBy submitting this form, I confirm that: The information provided is accurate and complete. I am authorised to register the property and participate in the Energy FIT Program. Pelican Energy TCI may review my account and historical electricity-use information to verify eligibility and support the assessment. An adult will be present during the scheduled home assessment. Pelican Energy TCI may collect, store and use information gathered during the assessment for program administration, reporting and follow-up communication. Recommendations provided through Energy FIT are for guidance. Participants are responsible for deciding which recommendations to implement. The program does not guarantee a reduction in my electricity bill. Results will depend on household energy use, recommendations implemented, behavioural changes, equipment and other factors affecting consumption. (Required.) I have read and agree to the Energy FIT Terms & Conditions. Question Title * 8. PHOTO & VIDEO CONSENTPlease select one: (Required.) I consent to the use of photographs and/or video taken during the assessment for documentation, training, educational, and promotional purposes. I do not consent to the use of photographs and/or video beyond assessment documentation. Question Title * 9. ENERGY USAGE HABITS Which of the following do you use the most in your home? Select all that apply. (Required.) Air conditioning Electrical stove Dishwasher Laundry appliances Water heating Lighting Not sure Question Title * 10. How often is your air conditioner used (if applicable)? (Required.) Most of the day Evenings only Occasionally I do not use air conditioning Question Title * 11. What is your primary reason for requesting a Home Energy Assessment? (Required.) Higher than usual electricity bill Learn how to use energy more efficiently Identify energy waste in my home Improve home comfort Other (please specify) WHAT HAPPENS NEXT? We will review your application and contact you regarding your eligibility. Eligible applicants will be scheduled for a home energy assessment based on our next available home visit appointment date..Your results from the Energy FIT Program will depend on the energy-saving recommendations you choose to follow. While all recommendations are optional, implementing them can help you achieve greater energy savings and efficiency. Done