Pre-Audit Form

Name *

First Last

Address *

Street Address City State ZIP Code

Property Type *

Phone *

Email *

What are your goals with this Energy Audit? *

Approx. Year of Construction *

Age of Roof

Summary and Age of Additions

Architectural Style of Home

If Known: Insulation Type in Walls, Attic, Basement

Number of Separate Apartments in Building

Number of Occupants

Number of Bedrooms

If Known: Square feet above grade

Is the basement heated?

Please list cold or hot spots in the building and specific issues we need to address: *

Do you have Carbon Monoxide detectors?

Laundry Dryer

What fuel does it use?

Kitchen Cook-top

What fuel does it use?

Kitchen Oven

What fuel does it use?

Do you use a Dehumidifier?

If so, how many hours a day? How many days a year?

Do you use an Air-Conditioner?

If so, how many hours a day? How many days a year?

Age of Refrigerator in years

Leave blank if unknown or not applicable.

Age of Freezer in years

Leave blank if unknown or not applicable.

Age of Air Conditioner in years

Leave blank if unknown or not applicable.

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Which electric utility do you have?

Do you have any high use electrical equipment?

If so, what?

What fuel does your Hot Water Heater use?

Hot Water Heater type

Primary Heating Fuel

What fuel does your home’s primary heat source come from?

Primary Heating Fuel Cost

For example, $1,350 in oil last winter

Primary Heat Distribution

How is heat dispersed around your home?

Primary Heating Fuel Delivery Schedule(s)

You can contact your fuel provider or dealer to obtain this information and attach separate sheets if necessary. Please share 2 years of delivery records showing units (e.g., gallons) delivered and their related delivery dates. For example, 250 gallons delivered on 11/11/2019, 288 gallons delivered on 1/11/2020, etc.

Primary Heating Fuel Records

Drop files here or

Max. file size: 300 MB.

Attach files related to your fuel delivery schedule.

Secondary Heating Fuel

What fuel does your home’s primary heat source come from?

Secondary Heating Fuel Cost

For example, $230 a cord

Secondary Heat Distribution

How is heat dispersed around your home?

Secondary Heating Fuel Delivery Schedule(s)

You can contact your fuel provider or dealer to obtain this information and attach separate sheets if necessary. Please share 2 years of delivery records showing units (e.g., gallons) delivered and their related delivery dates. For example, 250 gallons delivered on 11/11/2019, 288 gallons delivered on 1/11/2020, etc.

Secondary Heating Fuel Records

Drop files here or

Max. file size: 300 MB.

Attach files related to your fuel delivery schedule.

Electric Utility Provider

Name on Account

Please provide information about your electrical usage for the last 12 months: *

If unknown or only partially known (e.g., new homeowner), please enter any information you may have related to electrical usage, or enter “not known.”

Average Electric Payment

Please upload the most recent copy of your electric bill

Drop files here or

Max. file size: 300 MB.

Additional Information

Please use this space to detail any other relevant information.

Additional Files or Uploads

Drop files here or

Max. file size: 300 MB.

Please use this space to upload any other relevant information.

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Account Number

VT Residents: We will access your electrical use through Efficiency Vermont.

Comments

This field is for validation purposes and should be left unchanged.

Pre-Audit Form

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