Pre-Audit Survey

Please complete this survey if you would like to have an Energy Assessment performed on your home. If you are unsure of an answer, or the question does not apply to you, type "N/A".

Thank you,
The Easy Energy USA Team

Homeowner Information

AUDIT ADDRESS

Full Name *

Audit Address Line 1 *

Audit Address Line 2 *

Audit City *

Audit State *

Audit Zip Code *

Email *

Phone Number *

MAILING ADDRESS

Is your mailing address different than the audit address? *

Yes No

Mail Address Line 1

Mail Address Line 2 *

Mail City *

Mail State *

Mail Zip Code *

Building/Occupant Information

Approx square feet of living space? - How many occupants? *

When was the home built? How long have you resided there? *

Type of Foundation? *

Floors on or above grade (ground)? *

Have you remodeled or upgraded your home? Briefly explain: *

Do any of the occupants suffer from respiratory ailments? *

Do you experience hot or cold rooms, drafts, or dampness? *

Do you ever notice any seasonal moisture issues? (Peeling Paint, Water Stains, etc) *

Who are your electric and fuel providers? *

Primary Heating Fuel *

Water Heater Fuel *

Primary Heating System (Furnace, Boiler, Electric Baseboards, etc) *

Do you have Central Air Conditioning? *

How many thermostats? *

Are they programmable? *

Heating Thermostat Setting *

Cooling Thermostat Setting *

Is there duct work? *

Is duct work shared? *

Type of fuel used for range & oven? *

Type of fuel used for clothes dryer? *

Do you use any supplemental heating/cooling for additional comfort? Type & Fuel? *

Additional Information

Have 12 months of utility bills? What are your approx. utility costs? *

List other energy-intensive devices (Hot Tub, Pool, Waterbed, Well Pump, Aquarium, Crawlspace Heater, etc) *

Approx. Percent of Efficient Lighting (Fluorescent, LED) *

List all ventilators installed your home. (Bath Exhaust, Range Exhaust, ERV/HRV, etc) *

Type of windows? (Single Pane w/ Storm, Double Pane, etc) *

How many refrigerators and freezers are in the home? Approx. age? *

How did you hear about us? *