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Home Energy Evaluation
First name
*
Last name
*
Email
*
Phone
Account number
Address line 1
*
Address line 2
City
*
State
*
Zip
*
Monthly kilowatt hour (kWH) use
Coffee maker
Convection oven
Electric oven
Refrigerator (apartment size or under counter)
Refrigerator (standard size)
Please list any other important information about how you use electricity in your kitchen, such as under sink water heaters or additional large appliances.
Air conditioner
Air conditioner central air (tons if known)
Air source heat pump (system size in tons if known)
Electric baseboard heat (total length of baseboards in feet)
Electric ceiling heat (house square footage)
Fan(s)
Electric fireplace (1500 Watt)
Electric furnace (Size kW or circuit breaker amps)
GeoExchange heating cooling system (system size in tons)
Heat tape (number of feet)
Humidifier
Portable space heater (1500 Watt)
Stove space heating (Watts)
Swamp cooler
Please list any other important information about how you use electricity to heat or cool your home.
Clothes dryer
Electric water heater (number of people)
Freezer
Hot water recirculation pump
Sewage ejector or lift pump
Sump pump (to remove water from under the house)
Water pump (domestic water for whole house)
Computer
Oxygen concentrator
Television
Whirlpool bathtub
Waterbed
Lighting (total number of standard incandescents)
Lighting (total number of compact fluorescent bulbs)
Lighting (total number of LEDs)
Fish tank (list number of gallons)
Please list any other important information about your home's indoor energy use.
Hot tub
Air compressor (floor mounted)
Engine heater (truck, car, tractor, or utility)
Battery charger 6 volt or 24 volt for deep cycle batteries for golf cart, etc. (list quantity of each)
Battery charger (electric vehicle such as Chevrolet Volt, Tesla, etc.)
Welder / welder type
Christmas / outdoor lights
RV plugged into house
Stock tank heater
Well pump irrigation
Yard lights
Please list any other important information about your outdoor energy use.
Other: Do you have any unique circumstances we should know about, such as a home business that requires equipment or additional medical equipment?
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