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home energy checkup

Home Energy Checkup Form

* denotes a required field.
Name *:
(as it appears on your electric bill)
Address 1:*:
(where property is located)
Address 2:
Directions to Property:*:
Email *:
Home Phone*:  
Cell Phone:  
Work Phone:  
 

Home Information
Contstruction*:

Heating System *:
Complete all that apply How many?
 
 

Cooling System*:
Complete all that apply How many? Brand/Model# Age
(if known)?
     

Exterior walls of house*:
Complete all that apply
 

Roof*:
Complete all that apply
 

Insulation*:
Complete all that apply

Water Heating System *:
Complete all that apply How many?
 

Please list any concerns that you may have with your home's energy performance:

What is your reason for requesting this energy check up:


  



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Kids Korner

Washington EMC • 258 North Harris Street Sandersville, Georgia 31082 • (478) 552-2577 • 1(800) 552-2577