Weatherization Intake Form
Use this questionnaire if the customer would like to make their home/business more energy efficient.

If no answers to required questions then type "n/a." If the client does not want to proceed the Program Questions [section 2] then type "n/a" in each line item or select "None Known Of."

Questions in [brackets] are instructions for you and not to be relayed to the customer.
First Name *
Last Name *
Phone *
Is this a cell phone, home or business line? *
Email *
What is your preferred contact method? [Select all that apply] *
Is this for a residence or commercial property? *
Address *
City *
State *
Zip *
Were you referred by anyone or any program? [If not given, select "Cold Call"] *
Would you like to list an additional contact? If so, who would you like as your secondary contact? *
What is the best number for the secondary contact? *
What is the best email address for the secondary contact? *
Would you like our team to do the following? *
So we can accomodate your schedule, when would you like us to come out to your residence? Are there better days or times in the day? Someone will call to schedule *
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