EnergyWorks Application

Fields marked with a red asterisk are required.

Please note: EnergyWorks is for homeowners in Bucks, Chester, Delaware, and Montgomery counties, and the City of Philadelphia.

About You

First Name: *

Last Name: *

E-mail Address: *

Primary Phone: *

Secondary Phone:

Street Address: *

Unit Number:

City: *

County: *

Zip Code: *

About Your Home

How large is your home?

Square Feet: * sq. ft.

Square footage includes any space in the home that is intentionally conditioned and finished as livable space. *This includes finished basements and finished attics.

Bedrooms: bedrooms

Bathrooms: bathrooms

Floors: Floors

Number and location of each in your home

Heaters: * quantity and location:

Hot water heaters: * quantity and location:

Central air conditioning systems: * quantity and location:

How do you heat your home?:

How do you heat your water?:

Approximately how much do you spend each year on the following?

Electric: $

Gas: $

Oil: $

Other: $

Are your utility bills a challenge?:

Do you have utility data from the past month or earlier?:

If yes, it would be very helpful if you could send any utility data, such as last month's PECO or PGW bills, to the address below or electronically to KathrynR@ecasavesenergy.org.

What improvements are you considering in your home?:

How soon would you like to start the work?:

Renovations

Has your home ever been renovated?:

If yes, year of last renovation:

If yes, what renovations were performed?:

When was your home built?:

How long do you plan to stay in your home?:

How many people reside at your home?:

What is the style of your home?:

Have you had any problems with...:

Flooding when it rains?

Mold or mildew?

Roof leaks?

Paint peeling?

Any other problems?:

At what temperature do you typically keep your thermostat in the summer months?: degrees

At what temperature do you typically keep your thermostat in the winter months?: degrees

Do you have any very hot or very cold rooms?:

Do you have an attic?:

Will the analyst have open access to the attic, the basement, and any crawl spaces?:

Is there any knob-and-tube wiring, to the best of your knowledge?:

How did you find out about us?:

* If you have a code from an EnergyWorks@Work event, please enter in the "Please Elaborate" box.

Please elaborate:

Would you like a particular building analyst to perform the assessment?:

If you have an established relationship with a building analyst or know of one you would like to work with within our program, state his or her name or company here.

Talk about your home! Give us as much detail as possible, and mention anything we didn't already ask about.:

Are you part of a neighborhood or homeowners association?:

If you are part of a neighborhood or homeowners association, you could be eligible for special discounts.

Other association: