Date: Member's Name Acct. # Address City State Zip


[PDF]Date: Member's Name Acct. # Address City State Zip...

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  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)