Clean Energy for WNC This form contains three sections. We recommend that you have your utility information ready before you begin. If you are enrolling new construction or do not have complete data, that is okay. Please fill in as much information as you can; make an educated guess if you are unsure; and use the comment box at the end to share any additional information relevant to your situation. We will follow up with you if we need more information. After you have submitted your form, we will review your information and pass it on to the appropriate contractor. They will contact you to set up a free and no-obligation home energy audit or solar site assessment. We will keep your information secure and confidential and will only use it for this campaign. Thank you again for taking the first step towards adopting clean and more efficient energy in your home, business, or organization. Step 1 of 3 33% Are you applying a residence, business, or tax-exempt entity?ResidenceBusinessTax-ExemptWhat county is your site in?*What neighborhood?What is the name of the business?What is the name of the entity?What is the physical address of the site you are enrolling?We will use satellite imagery to assess the site for solar suitability. Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code What is your name? (First and Last)* First Last What is your relationship to the site you are enrolling? (i.e. owner, manager, occupant)What is your email address? What phone number should we call if we have questions about your assessment?Use this format: (###)###-####How did you hear about the Clean Energy for WNC campaign?* What electricity company services your site?DukeFBEMCOtherPlease specify your electric company:What are you interested in exploring? (You may chose more than one.) Solar Photovoltaic (PV) Solar Thermal Energy Efficiency Other I don't know Please specify your other interest:Are you primarily motivated by economic or environmental reasons or both?EconomicEnvironmentalBothHave you ever had an energy efficiency audit performed?YesNoWho performed the energy audit?Have you ever had a solar site assessment performed?YesNoWho performed the solar assessment?Is your home green certified?YesNoIf you are interested in solar, please describe the repair, age, and composition of your roof: Please upload your most recent bill for the following utilities (if available): Fuel, Electric, WaterUpload all that apply. The limit is 8MB. Drop files here or Please describe the site’s utility usage:Ideally this includes two years of electricity data (Kwh per month), 12 months of fuel data (gallons for fuel oil; therms for gas; cords for wood), and two years of water data (CCF.) If you cannot find the units, then use the dollar amount. How do you heat your site? Oil Natural Gas Electricity Propane Heat Pump Other Please specify your other heating source:How do you heat your water? Natural Gas Electricity Propane Other Please specify your other water heating source:Year structure was built:Square footage of structure:Number of people using structure: If you are a homeowner or business owner, will you pay federal taxes this year?YesNoI don't knowIf you are a homeowner or business owner, will you pay NC state taxes this year?YesNoI don't knowA home energy efficiency retrofit is designed to payback within 5-7 years and, on average, costs between $1,500-$4,000. These costs may be financed over several years. Are you comfortable making an investment in this range?YesNoN/AOnce you receive recommendations on how to make your home more efficient, do you plan on doing the work yourself or hiring a professional to do the work?I do not plan on doing any work after I receive recommendationsI plan on hiring a professional to implement recommendationsI plan on doing the work myselfA typical solar thermal system pays back in 8-12 years and costs between $7,500-$9,000. The upfront cost may be financed over several years and customers with tax liability can get up to 60% of this investment back from tax credits. Are you comfortable considering an investment in this range?YesNoN/AA typical solar PV system pays back in 8-12 years and costs between $15,000-$25,000. The upfront cost may be financed over several years and customers with tax liability can get up to 60% of this investment back from tax credits. Are you comfortable considering an investment in this range?YesNoN/ADo you plan to purchase directly or would you like to explore financing?Purchase DirectlyExplore FinancingDo you have an open home equity line of credit (HELOC) or the ability to get one?To get a HELOC, you must have equity in your home and a decent credit score. For more information on HELOC, see the Wikipedia article: HELOC - Home Equity Line Of CreditYesNoI don't knowAny additional comments or questions you have here: CommentsThis field is for validation purposes and should be left unchanged.