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Low Carbon Diet Home
If you are interested in having an ecoENERGY for Houses energy evaluation performed on your home, please complete the following form.
Name:
Address:
City:
Postal Code:
Mailing Address:
(if different than street address)
Phone1:
(primary daytime number)
Phone2:
(alternate daytime number)
E-mail:
Who are your current energy suppliers?
Gas:
Electricity:
Propane:
Oil:
How did you hear about ecoENERGY?
Presentation/Seminar
Environment Network
Mail
Govt of Ontario Website - Min of Energy
TV
Govt of Canada Website - Natural Resources
Newspaper (which one):
Flyer (where did you pick one up):
Radio
Friend/Family
Store:
Other
Company/Contractor (who):
If you are planning to do any renovations or upgrades what are they? (check all that apply)
None Planned
Windows
Heating System
Hot Water Tank
Cooling System
Toilet Replacement
Insulation
Air Sealing
Have you already started renovations to your home?
Yes No
Are there any additions on your home?
If so, please indicate how many If so, please indicate size (ft2):
Size of home (ft2): Year built: No. of occupants:
Type of home: (select one) Bungalow Split Level 1 1/2 Story 2 Story Bilevel Other Other:
Is the attic accessible?
Yes No Not Sure
Where is the attic opening?
Inside Outside Not Sure
Do you have more than one attic?
Do you have more than one basement?
Do you have a fireplace?
If yes, what type of fireplace? (select one) Wood Natural Gas Not Sure Other Other
If you have any specific concerns that you would like us to address, please describe them here:
Please Note:
