LI Green Free Home Energy Audit Request Form

If you're interested in receiving a home assessment from OHCC and LI Green, please fill out the form below. A representative will contact you shortly.

* = Required Field

Name: * (First, MI, Last)	Mr.   Ms.   Mrs.
Address: * (City, State, ZIP)
Phone: *	() -
E-mail Address: *
Name of Fuel Dealer/ Comfort Provider	Need a fuel dealer/comfort provider? Click here
Number of persons in home:	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Age of home (years):	new 1-5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80 81-85 86-90 91-95 96-100 101+
Age of appliances in home:	new 1-5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80 81-85 86-90 91-95 96-100 101+
Approximate square footage of home:	500 600 700 800 900 1,000 1,100 1,200 1,300 1,400 1,500 1,600 1,700 1,800 1,900 2,000 2,100 2,200 2,300 2,400 2,500 2,600 2,700 2,800 2,900 3,000 3,100 3,200 3,300 3,400 3,500 3,600 3,700 3,800 3,900 4,000 4,100 4,200 4,300 4,400 4,500 4,600 4,700 4,800 4,900 5,000
Total number of rooms:	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Number of bathrooms:	1 2 3 4 5 6 7 8 9 10
Number of bedrooms:	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
What is your home built on?	A Slab A Foundation
Have you or recent previous owners made any construction changes (for example, large additions, new windows, additional insulation, etc.)?	Yes No
Do you have any areas of concern in your home regarding your energy use (high heating bills, high electric bills, drafts, colds spots, hot spots, etc.)?	Yes No
Do you supplement your home heating and hot water with non-standard fuels/energy sources (wood pellet stove, propane, solar, geothermal, other)?	Yes No
Please check all that apply to your home: Accessible Attic Inaccessible Attic Crawlspace Unfinished Basement Finished Basement Attached Garage Oil Heating Gas Heating Electric Heating Separate Hot Water Heater Central Air        Wood Fireplace Gas Fireplace Gas Range Electric Range Kitchen with external vents Bathrooms with external vents Cold or drafty rooms Mold or mildew problem Unknown odor or smell Heated pool
Please describe the electrical load of your home: (i.e., workshops, welding, power tools, etc.)
Please enter any other details about your home: