Regististration Form
You can register your interest for the Hepburn Z-NET Home Energy Assessments and Energy Savvy Upgrades program by filling in this form. You may qualify for a free assessment valued at about $330. A Victorian State Government subsidy valued up to $880 may also be available to help with energy-efficient upgrades to your home.
* Required
Email address
*
Your email
Are you seeking help to better understand and manage your energy bills?
Yes
No
Clear selection
Are you interested to have a Victorian Residential Efficiency Scorecard Assessor conduct a free home energy assessment at your home, or rental property?
*
Yes
No
Do you identify with any of the following (multiple answers ok)
*
You are on a low income or currently unemployed
You have or care for someone with a long-term medical condition or disability
You are suffering bill stress - utility bills are sometimes difficult to pay on time
You rent or own a home that is uncomfortably hot or cold in summer or winter
You rent or own a home that has old or poor condition fixed appliances
You want to reduce your carbon emissions by improving the energy efficiency of your home
Required
What is your name?
*
Your answer
Your best contact phone number?
*
Your answer
How would you like to be contacted?
*
Email
Either Telephone or Email
Telephone
What is the postcode where the assessment would take place?
Your answer
What is the address that the home energy assessment would take place?
*
Your answer
Do you have the capacity and are you willing to co-pay for a part-subsidised upgrade? The program will subsidise 50% of the cost of upgrades up to a maximum of $880. Residents or landlords will need to pay the remaining 50% of the total cost.
*
Yes
No
Maybe
Other:
What is your status in relation to the property you would like us to assess?
*
Home Owner Occupier Main Place of Residence
Tenant of Rental Property
Owner Landlord Long Term Lease
Business Owner or Commerical Tenant
Farm Property Owner
Owner Short Term Holiday Accomodation
Other:
Are you willing for your property to be included as a case study to help advertise this program to a wider audience online and via other media? (Not required)
*
Yes
No
Maybe - need more information
If you have any other questions, feedback or other comments, please add them here
Your answer
How did you hear about our program
Please check all that applies
Social Media
Email
Newspaper or other print media
Word of Mouth from friends, family etc
Public information session
Assessor or supplier direct
Hepburn Shire related material or staff
Radio or TV
Other
Please check all that applies
Social Media
Email
Newspaper or other print media
Word of Mouth from friends, family etc
Public information session
Assessor or supplier direct
Hepburn Shire related material or staff
Radio or TV
Other
Would you like to receive our project newsletter and other Hepburn Z-NET project related updates via email? You may opt out any time by emailing 'unsubscribe' to
assessor@hepburnznet.com.au
Yes
No
Clear selection
Are you a Hepburn Wind member?
Yes
No
Clear selection
Send me a copy of my responses.
Submit
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