Movimiento Comunitario para Energía Eficiente
Community Energy Efficiency Movement
Zip-Code *
Your answer
Gastos aproximados en utilidades al mes: Approximate amount paid for utilities monthly: *
Required
Cuán viejo es su refrigerador? How old is your refrigerator? *
Quien es el dueño de su refrigerador? Who owns the refrigerator in your apartment? *
Cuán viejo es su aire acondicionador? How old is your air conditioner? *
Quien es el dueño de su aire acondicionador? Who owns the air conditioner in your apartment? *
Que tipo de bombilla usa/compra usualmente? What kind of light bulbs do you use?
Alguna vez ha comprado o recibido enseres a través de algún programa público? Have you ever received or purchased new energy efficiency appliances through an upgrade program?
Quiere recibir mas información de esta iniciativa? Would you like to be included in updates, announcements and developments in our Count, Locate, Replace, Recycle Your Old Energy Wasting Appliances campaign?
Le gustaría que lo contactemos para una visita a su domicilio? Count, Locate, Replace, Recycle Your Old Energy Wasting Appliances campaign, can we contact you?
Seleccione la más que le aplica: Check the boxes that apply to you: *
Required
Thank you for your input!
¡Gracias!
Submit
Never submit passwords through Google Forms.
This form was created inside of Loisaida Inc..