Eco Energy of NY LLC - Customer Intake Form
Here at Eco Energy of NY, we work hard to tailor appropriate measures for not only your home's energy efficiency  and safety, but for your personal comfort and budget. In order to schedule an appointment most suitable to your needs, we ask that you provide us with some background information. All answers are securely stored on our server. After we've received your results, someone will be in touch with you to schedule your free home energy assessment and provide you with more information and resources!
Email *
Address of Home Receiving Audit *
First and Last Name *
Best Way to Reach You *
Primary Phone Number *
Secondary Phone Number
E-Mail Address
What kind of assistance are you interested in? *
Required
Please briefly explain specific concerns you have with your property.
For Example; hot water runs out, breeze comes in through windows, furnace doesn't work properly, heating/cooling doesn't distribute properly, etc.
Choose a Home Type *
Are you an Owner or Renter? *
Which Utility Company Supplies Your Electric? *
What is your primary fuel?
Clear selection
Who provides your primary fuel?
Clear selection
Are you interested in hearing about financing and subsidy information through NYSERDA*? *
New York State Energy Research and Development Agency
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