CT Energy Audit Fundraisers

The following questions will provide us with the necessary information in order to confirm that you qualify for a home energy assessment and to obtain information for us to begin the process. If you qualify you will be contacted within the next 24 hours to schedule your assessment. All completed paid assessments will be eligible for the benefit donation.

Must reside within an Eversource or United Illuminating territory
Customers must not have had a previous energy assessment through their utility company
Municipal electric customers do not qualify – you can call us directly for other program options
There is no commitment except for the co-pay amount based on your heating source
A portion of the co-payment will be donated to the fund that you choose

Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Best Daytime Number*

Area CodePhone Number

Is this number available for SMS/MMS text messaging and do you give Connecticut Home Solutions authorization to send confirmation texts or promotional texts in the future?*

YesNo

Alternate Number

Area CodePhone Number

E-mail*

Do you own or rent?*

OwnRent

To your knowledge have you ever had a home energy assessment completed on your home?*

YesNo

Electric Utility*

Type of Home*

What year was the home built?*

What is the approximate square footage of the home?*

What is the primary heating source for your home?*

Do you have duct work in your home?*

YesNo

Gas, Propane or Kerosene unvented fireplaces or heaters in your home?*

YesNo

Wood fireplace?*

YesNo

Are you aware of mold, asbestos or vermiculite in your home?*

YesNo

In order to schedule your energy assessment you must provide us with an Eversource or United Illuminating account number. If you choose not to provide it at the time of the questionnaire you will need to have it ready when the service representative contacts your for your appointment. This account number is required to provide the assessment service and appointments cannot be scheduled without a valid number.

Account Number

Portion of your co-pay to a fund of your choice:*

By answering these questions I understand that I have provided information in order for a representative to contact me to schedule an energy assessment through one of the utility authorized vendors. I also understand that I will be required to pay a co-pay depending on my heating source of my home. For a limited time the co-pay for all customers has been reduced to $75.*

AgreeDisagree