Heat Pump Water Heater Campaign

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

We're delighted to hear you're interested in a heat pump water heater as part of the pilot electrification program run by the Towns of Fairfax and San Anselmo with ReadySetReplace™. Please fill out the requested information below to receive information on next steps.

Email *

Phone number

What’s your interest in electrifying your water heating? (choose all that apply)
*

I’d like to do it right away (less than a month)

I want to be prepared for doing it sometime in the future (3-6 months)

I want to do it as part of a bigger electrification upgrade, including HVAC (6 months +)

Other:

Name (First, Last) *

Where do you live? *

San Anselmo

Fairfax

Other:

Take the pledge to not replace with gas! We won't actually hold you to it, but it helps to show that our Towns have momentum!

My next water heater won't be gas! Ok to show my name to motivate others!

My next water heater won't be gas! I prefer to stay anonymous.

Other:

We are partnering with Resilient Neighborhoods!

Are you a graduate?

Yes!

No, but I'd like to learn more!

Clear selection

Anything else you'd like to share?

By clicking submit, you agree to be contacted regarding this pilot program and to be referred to ReadySetReplace’s affiliate qualified local contractors. Thank you!

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of ReadySetReplace. Report Abuse

Forms