Please complete the below questions to register your interest for a FREE home energy efficiency assessment using the State Government's new Residential Efficiency Scorecard tool.

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* 1. What is your first name?

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* 2. What is your family name?

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* 3. What is your street address?

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* 4. What is your suburb?

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* 5. What is your preferred phone number?

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* 6. What is your email address?

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* 7. What is your preferred method of contact?

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* 8. Does anyone in your household hold any of the following concession cards?

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* 9. How did you find out about the Residential Efficiency Scorecard (the Scorecard)?

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* 10. Any comments you would like to add?

Thank you for your time and interest!

We will contact you shortly to confirm your eligibility and to book in your home energy efficiency assessment.

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