Customer Intake Form is an energy efficiency project development and management company that specializes in renewable energy and building electrification optimizing available financial resources.
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Email *
First Name *
Last Name *
Property Address *
Phone Number *
How did you hear about us? *
Owner or Tenant? *
What kind of home improvements are you interested in? *
Are there any planned improvements to the home? *
Please share your future energy plans for your home. If there are planned improvements, please describe.
Have you noticed any of the following home health hazards? *
Have you had an energy audit or home health assessment in the past? *
Are you aware that there may be Energy Efficiency / Electrification Rebates you might qualify for? *
Does any resident participate in any income, utility cost, housing or food assistance programs? *
Are there any seniors or children under the age of 6 in the home or visit regularly? *
How do you plan on funding the project?
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What are the best days/times to schedule your energy audit?
Any additional information you'd like to share about your home improvement interest?
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