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 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict 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.).Great, we love installing heat pump water heaters! On the following pages we will ask for some dimensions and photos. If you are able to provide these, we can typically get you an estimate within 2 business days. If you don’t have a tape measure or camera handy, or can’t safely go into the location – no problem, we’ll get this information later on. How did you find us? * We like to know how people find us and also reward those who provide referrals!FacebookOnline 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.What is your home's electrical service capacity? *You can typically reference your primary electrical panel’s main disconnect (printed on the switch) or on the panel’s nameplate label. See photo examples for reference.I'm not sure30 Amps60 Amps100 Amps125 Amps150 Amps200 Amps>200 AmpsDoes 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+Do you have a jet-style or large capacity bath tub? *YesNoNumber of occupants *Pick from list123456+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.Where Is Your Heating System Located? *AtticIndoor ClosetUnder House (e.g., Basement or Crawlspace)Equipment RoomUnsureDo 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 HouseAtticDimensions of space surrounding your water heater These dimensions help us calculate the available air volume in your water heater locationHeight in Feet + Inches Floor to bottom of floor joist or ceiling (whichever is lower) in feet and inches. Closets: measure the inside of the enclosure at the most narrow points; if wood framing exists, take measurements from the inner edges. Basements/Crawlspaces/Attics: width is optional if >30. Height should be taken from floor to lowest framing member above water heater location.Width in Feet + InchesWall to wall in feet and inches. Closets: measure the inside of the enclosure at the most narrow points; if wood framing exists, take measurements from the inner edges. Basements/Crawlspaces/Attics: width is optional if >30. Height should be taken from floor to lowest framing member above water heater location. Depth in Feet + Inches Wall to wall in feet and inches. Closets: measure the inside of the enclosure at the most narrow points; if wood framing exists, take measurements from the inner edges. Basements/Crawlspaces/Attics: width is optional if >30. Height should be taken from floor to lowest framing member above water heater location.Dimensions of best access door Sometimes water heaters can’t fit into the spaces we need it to go. These dimensions help us know whether the new unit can fit into the door/hatch/opening.Height in Feet + InchesInside of door frame in feet and inches. Closets: measure the opening of the door frame at the most narrow points. Basements/Crawlspaces/Attics: measure the inside frame of the access door into the water heater location. Width in Feet + InchesInside of door frame in feet and inches. Closets: measure the opening of the door frame at the most narrow points. Basements/Crawlspaces/Attics: measure the inside frame of the access door into the water heater location. How 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+ secondsUnknownIs your current water heater adjacent to any bedrooms or noise-sensitive rooms? *YesNoApproximate distance from water heater to the closest electrical panel in feet + inches *PreviousNextHome 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 Showing Breakers 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. HPWH Only FieldsFile Upload – Electrical Panel Showing Breakers 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. File Upload – Water Heater Nameplate Please attach a picture of your water heater nameplate. 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
