Please enable JavaScript in your browser to complete this form. – Step 1 of 7In order to prepare your customized home electrification upgrades, we’ll need to learn a little more about your home! Fill out this seven-step questionnaire to give our team the info we need about you, the services you are interested in, and the current state of your home – including questions about your heating and cooling system, the layout of your home, your hot water heater, windows, attic, among other details. Tell Us About You Name *FirstLastLayoutEmail *Phone *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeNextYour Electrify My Home Journey Which service are you interested in? Select all that apply. * Not sure? That’s fine, just pick one or two items to start the process.Ducted Heat PumpDuctless Heat PumpHeat Pump Water HeaterInsulationEV ChargingSolarOther Appliances (Dryer, Induction Cooktop, etc.).How did you find us? * We like to know how people find us and also reward those who provide referrals!FacebookGoogle SearchReferralOtherReferral Name * Please enter the name of the individual who referred you to Electrify My Home.Other * Please explain how you found us.What is your timeline for completing your first electrification upgrade with us? *1 month2-5 months6-12 months1+ yearNot Sure – Just Looking For InformationPreviousNextTell Us About Your Home Home square footage * Please provide your home’s square footage. If you’re unsure, an estimate will be fine.How many stories? *11.522.53456+My house was built in… * Please select the year your house was built. If you’re unsure, an estimated year will be fine.Does your home have knob-and-tube wiring? Knob and tube wiring has porcelain insulating tubes with porcelain knobs to secure wires, typically original to older homes before 1950.YesNoI’m not sureDoes your home have galvanized piping? Galvanized pipes are steel pipes dipped in zinc coating, common to homes built before 1960.YesNoI’m not sureDoes your home have asbestos? Asbestos comes in many forms, but it is commonly found as a white material insulating older HVAC ducts and systems.YesNoI’m not sureWhat kind of foundation do you have? * Please select your home’s foundation type. If you’re unsure, you may select ‘Other’ and provide further explanation of what your basement looks like..Concrete SlabBasement (Finished)Basement (Unfinished)Crawlspace (Dirt)Crawlspace (Vapor Barrier or Concrete)Other – explain belowOther type of foundation * Please describe your home’s foundation.Number of bedrooms *Pick from list12345678910+Number of bathrooms *Pick from list11.522.533.544.555.56+PreviousNextHome Comfort I heat my home with * Please select the type of home heating system that you use.GasElectricDoes your home have a central heating system? *YesNoHow many vents/registers do you have? * An estimate is OK if not readily available.Do you have air conditioning? *YesNoPlease choose the type of air conditioning you have *Wall ACCentral ACPortable ACDoes your home have any noticeably uncomfortable rooms? * Some examples of uncomfortable rooms may include those that are too chilly in the winter or too hot in the summer.Please rate your home comfort (winter) 1 2 3 4 5 6 7 8 9 10 On a scale of 1 to 10 with 1 being not comfortable and 10 being totally comfortable, please drag the blue dot to rank the overall comfort of your home in the winter.Please rate your home comfort (summer) 1 2 3 4 5 6 7 8 9 10 On a scale of 1 to 10 with 1 being not comfortable and 10 being totally comfortable, please drag the blue dot to rank the overall comfort of your home in the summer.PreviousNextHome Water Heater What type of water heater do you have? * Please select the type of water heater that is used in your home.Tank – GasTank – ElectricTank – Electric Heat PumpOn-Demand – Tankless GasOn-Demand – Tankless ElectricWhere is your water heater located? *GarageBasementOutdoor ClosetIndoor ClosetInside the HouseAtticHow long does it take to get hot water at your farthest faucet? * We know it’s an odd question – it’s ok if you need to check.Under 30 seconds30 – 60 seconds60-90 seconds90+ secondsUnknownPreviousNextHome Insulation & Attic Space What condition are your windows in? Select all that apply. *Please select as many answers as needed that best describe your home windows. They’re original to the houseI (or a previous owner) upgraded themThey need to be replacedDouble Pane windowsSingle Pane windowsPartially New windowsI’m not sureHow well insulated are your walls? * Please estimate how well you feel your home’s walls are insulated. It’s ok if you’re unsure.They aren’t insulatedNot very insulatedSomewhat insulatedWell insulatedPerfectly insulatedI don’t knowAre your floors insulated? * Please select whether your home’s floors are insulated or not. It’s ok if you’re unsure.YesNoPartiallyI’m not sureDo you have an attic? *YesNoIs your attic insulated? * Please estimate how well insulated your attic is, if you have one.Not insulatedSomewhat insulatedWell insulatedPerfectly insulatedI don’t have an atticPreviousNextFile Upload & Comments – please be sure to click submit to send your form The files below are extremely helpful for our estimating process.If you’re not able to provide them now, no problem! You can submit the form now and email photos later.LayoutFile Upload – Current Heating/Cooling System Please attach a picture of your current HVAC system, showing the unit and its surroundings. Click or drag files to this area to upload. You can upload up to 2 files. File Upload – Electrical Panel Please attach a picture of your electrical panel showing breakers, all subpanels, etc. Click or drag files to this area to upload. You can upload up to 2 files. File Upload – Water Heater Please attach a picture of your water heater. The photo should be from at least 5 feet away so as to show the area around the unit. Click or drag files to this area to upload. You can upload up to 2 files. LayoutOptional File Upload – Heat Pump Location Please attach a picture of the prospective location for an outdoor heat pump. Click or drag files to this area to upload. You can upload up to 2 files. File Upload – Floor Plan Please attach a picture of your floor plan, if you have one. Click or drag files to this area to upload. You can upload up to 2 files. File Upload – Other Please attach a picture of anything else that may be applicable. Click or drag files to this area to upload. You can upload up to 2 files. Comments – for anything not covered in this form (or if you'd like to expand on anything) *Submit
