Mobile Home Initiative Questionnaire

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 the survey. If you have a camera phone, the survey requests an optional picture of the underbelly of your home if you are able to provide one. This will help us determine if a heat pump is suitable for your home.

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. How did you hear about our program?

Please fill in your answer in the box below.

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

Cooling

Better heating

Save money

Help the environment

Other

4. 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.

17. If possible, please take a photograph of the area beneath or “underbelly” of your home. This will help our team determine if your home might be suitable for a heat pump system. Please be careful and only do this if it’s easily accessible.

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

18. Are you willing to have a member of the Efficiency Maine team visit your home after installation to ensure customer satisfaction?(Required)

Yes

No

19. Income Eligibility Verification Number (if known)

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

20. This project entails a co-pay contribution from the homeowner, payable by either one upfront payment of $2,000, or 50 monthly payments of $50 with an Efficiency Maine loan. I would like to pay for this project with a:

For more information about the Efficiency Maine loan, click here.

21. How many people reside in your household? (i.e, the number of occupants in the home)(Required)

22. Are you currently enrolled in the Arrearage Management Program (AMP)?(Required)

Yes

No

Mobile Home Initiative Questionnaire

Introduction

Home Information

Photo Upload