Application of Interest: * Solar PV Survey 10 KW (Monthly Electric Bill $250 - $750) Solar PV Survey 25 KW (Monthly Electric Bill $750 - $2000) Solar PV Survey 50 KW or more (Monthly Electric Bill Over $2500) Solar Hot Water System Heating Service Contract Hot Water Installation Have you looked into solar before? Yes No If yes, how long ago? 1-2 years 2-5 years Over 5 years If yes, what size were you considering? Company Name Physical Address 1 * Physical City Physical State - - Choose One - - Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Physical Zip     Building Type - - Choose One - - Office Space Warehouse Multifamily University / School Hotel / Retail Space Other # of Floors Perimeter Sq Ft * Business Type Owner Occupied Bldg Owner Tenant Electric Bill Information I am a Con Edison Customer I am a LIPA Customer Number of Electric Meters at Site 1 2 3 4 5 6 7 8 9 10 Monthly Electric Costs: $200- $500 $500 -$1000 $1000 - $2000 over $2000 Enter Electric Account Numbers Yes, I give National Grid Permission to review my electric bill for the purpose of this survey Optional Upload a Copy of Your Electric Bils Contact Info Section First Name * Last Name Title - - Choose One - - Property Manager Building Owner Facility Manager Board Member Director of Operations Contractor Other Phone * Cell Email * Mailing Address 1 (if different from Physical Site Address)   Mailing City Mailing State - - Choose One - - Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Mailing Zip Code Notes (Comments) Info for Solar Hot Water, only Hot Water System Electric Gas Oil Hot Water Use Pool Laundry Apartments Office Processing Heating No. of Apts No. of Bldg Occupants No. of Bathrooms Security Code *