First Name * Spouse Name Last Name * Address * NJ or PA only City / State / Zip * Municipality (Township/Boro) E-mail * Home # * Cell # Work #/ Extension Home - Square Feet (Living Space) How many people live in the home? 1 2 3 4 5+ Year Home was built How long have you lived in the home (in years) Architectural style of home Please Choose Bungalow Cape Cod Colonial Condominium Contemporary Duplex Raised Ranch Ranch Row Home Split-Level Townhouse Tri-Level Tudor Victorian Other How many stories 1 1.5 2 2.5 3 3+ Number of Heating/Cooling Systems Is your basement or crawl space easily accessible? Yes No Do you have water in either? Yes No If you have a basement, is it finished? Yes No N/A Do you have an attic? Yes No Is the attic accessible? Yes No Do you have vermiculite (looks like cat litter) in your attic? If so, it must be tested for asbestos before we arrive. Yes No What type of fuel do you have? Electric Natural gas Oil Propane Wood Other Yearly Energy Bill - Total Who is your utility company for the above? Are you interested in solar? Yes No Are you having solar installed by another contractor? Yes No Is there any construction going on in your home? Yes No How did you hear about us? Please Choose BASF employee Green Energy Forum or Talk Clean Energy Program Website CNN CSG Direct Mail Door Hanger Existing Customer Home Show 2009 Job Sign Newsletter Newspaper Radio Ad Referral TV Commercial Vehicle Website Yellow Pages What is your main reason for inquiring about a home assessment today?