Mobile Home Heat Pump Pilot Survey

Introduction

To check on the suitability of your home to receive a whole home ducted heat pump and to help size that heat pump we need to ask you some basic questions about yourself and your home. We will follow up with you directly about your eligibility and the next steps after you complete they survey. If you have a camera phone, the end of the survey requests a few pictures of your home and appliances if you are able to provide them. This will help us determine the electric load of your home and whether a heat pump would work for you.

1. Please provide your contact information

Name (first and last)(Required)

Name of mobile park or community

Address(Required)

Address 2

City/Town(Required)

State(Required)

ZIP Code(Required)

Email Address(Required)

Phone Number(Required)

2. Why are you considering a heat pump? (Select all that apply)

3. Do you currently have a heat pump in your home?(Required)

Yes

No

Photo Upload

Photos will allow us to further refine the needs and capabilities of your mobile home.

21. Please take a photograph of the circuit breakers by opening the hinged door. Please be careful and only do this if you feel safe. Do not take anything apart.

Accepted file types: jpg, jpeg, Max. file size: 32 MB.

22. Are you willing to remove your existing fossil fuel heating?

Yes

No

23. Income Eligibility Verification Number (if known)

If you don't already have one, get an Eligibility Verification Number by filling out the form here.

24. I understand that the project entails a 20% co-pay contribution from the homeowner, payable by either one up-front payment of $2000, or 50 monthly payments of $50.

Yes

No

25. Please provide any additional home details.

Mobile Home Heat Pump Pilot Survey

Introduction

Home Information

Appliance Information

Photo Upload