[PDF]Date: Member's Name Acct. # Address City State Zip...
3 downloads
321 Views
55KB Size
Date:
Member's Name
Acct. #
Address
City
State
Zip
HOUSEHOLD INFORMATION
*What type of structure is your residence?
Site-Built Framed House
Manufactured / Modular Home
Apartment
*What is the approximate square footage of your home?
*What year was your residence built? CONSTRUCTION INFORMATION
*If your home is a new home, do you know how much insulation (in inches or R-Value) you have in the following areas?
Attic / Ceilings
Walls
Floor
No
*Do you have double-pane windows or single-pane with storm window? Yes
*Does your home have attic ventilation?
Good
Some
None
HEATING SYSTEM INFORMATION
*How do you heat your home?
Electric Furnace
Propane Gas Furnace
Space Heaters
Baseboard Heaters
Other
*What year was the system installed?
*At what temperature do you set the thermostat? Day
Night
COOLING SYSTEM INFORMATION
*How do you cool your home? Central Air Conditioning or Heat Pump Window Units
*What year was the system installed?
No Air Conditioning
*What is the efficiency of your system(s) (in SEER or EER)?
*At what temperature do you set the thermostat? Day
Night
WATER HEATER INFORMATION
*What type water heater do you have?
Tank or Tankless?
Electric
Electric w/ Waste Heat Recovery
Gas Water Heater
Number of Water Heaters *What size Water Heater(s)?
gallons
LARGE APPLIANCE INFORMATION
*Refrigerators
How many refrigerators do you have?
*Freezer
How many freezers (separate from ref.) do you have?
MISCELLANEOUS INFO
*Swimming Pool Pump
If so, what horsepower is it?
How many hours is the pump operated per day?
*Well Pump
Do you have a well pump?
If so, what horsepower is it?
How many hours does it run? LIGHTNING INFORMATION
*Do you use outdoor flood lights?
* How many and what wattage?
ADDITIONAL COMMENTS
Please Return This Form To: Joe Marek HILCO ELECTRIC COOPERATIVE, INC. P.O.BOX 127 ITASCA, TEXAS 76055 1-800-338-6425 X 2289 254-687-2515 (fax)