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Application

In order to receive a Free or Reduced Cost Home Energy Audit, we need some information to get the process started. Below is a list of questions that will better serve us in getting you started with your Energy Audit. This will only take a few minutes of your time. Once you have answered the questions, click on the submit button at the bottom of the page. This will be sent directly to Blueox. Once we receive your application a Blueox Representative will call you to schedule your energy audit.

First Name Middle Initial Last Name

Building Address City State Zip
Mailing Address (If Different) City State Zip

Home Phone Cell Phone E-mail Address

Residential Buiding Type (5+ units do not qualify) Above Grade Conditioned Square Footage of Building
Single Family     2-Unit     3-Unit     4-Unit    


How did you hear about the Program? (Select one from each column)

Constituency Based Organization
Contractor
NYSERDA
Neighbor/Friends
Municipality
Energy Smart Coordinator
Other
Newspaper
Circular/Flyer
Home Show
Verbal
Radio
Television
Internet
Other

Please answer the following to the best of your knowledge:


What type of home do you have?
Mobile Home House Age of Home:

What equipment do you use to heat your home?
Boiler Furnace Other:

What energy do you use to heat your home?
Oil Kerosene Propane/LP Gas Natural Gas
Electric Wood Other:

What do you use to heat your hot water?
Oil Kerosene Propane/LP Gas Natural Gas
Electric Wood Other:

Are you interested in insulation for your home?
Yes No    

If you answered YES to insulation, where do you need it?
Basement Attic Walls  

Additional Comments or Questions



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