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Name:
Address:
Town:
Phone:
Email:
1. How many square feet is your home?
2. How old is your home?
3. What style is your home?
Ranch
Cape
Modular
Mobile
Camp
Contemporary
Victorian
Colonial
Mixed
4. Has your home been added onto or retrofitted? If so, when?
Yes
No
5. How long have you lived there?
6. Do you have any comfort issues in the home?
(e.g., hot or cold rooms, allergies)
7. What type of fuel do you use to heat with?
Oil
Propane
Natural Gas
Wood Pellets
Wood
Kerosene
Electricity
8. How much did you use last year?
9. What other fuel do you use?
Oil
Propane
Natural Gas
Wood Pellets
Wood
Kerosene
Electricity
10. How much did you use last year?
11. What type of insulation do you have in your attic?
Don't Know
Fiberglass
Cellulose
Spray Foam
Foam Board
Vermiculite
Other
12. How thick is it?
None
4"
6"
8"
10"
12"
15"
18"
More
13. What type of insulation do you have in your walls?
Don't Know
Fiberglass
Cellulose
Spray Foam
Foam Board
Vermiculite
Other
14. How thick is it?
None
4"
6"
8"
15. What kind of basement do you have?
Full
Crawlspace
Mixed Basement and Crawlspace
None
Other
No
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