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What is your preferred language?*
English
Spanish
Portuguese
Haitian Creole
Cape Verdean Creole
Vietnamese
Mandarin
Cantonese
Khmer
Arabic
Another language
Is the building you are inquiring about a home or a business?*
Home
Business
Select the benefits you are interested in by checking the boxes below. Check all that apply.
No-cost Home Energy Assessment
Heating, ventilation, and air conditioning (HVAC)
Heat pumps
Solar energy
What is your first name?*
What is your last name?*
Primary Phone Number
Secondary Phone Number
Primary Email Address
How did you hear about the program?*
Social media
From a friend
Letter/flyer
At an event
Another organization
Someone came to my door
Other
What is the address of the building you are inquiring about?*
Address
Address Line 1
Address Line 2
City
Postal Code
Who owns and occupies the building?*
I own the building, live in the building, and there are no tenants
I rent my unit in the building or I rent a single family building
I own the building but rent out all of the units
I own the building, live in one unit and rent the others
What is your home heating fuel?*
Gas
Oil
Electricity
Propane
Other
Who is the electric utility?*
Eversource
National Grid
Municipal
Unitil
Liberty
Who is the gas utility?*
Eversource
National Grid
Unitil
Liberty
Berkshire Gas
Whose name is on the electric and/or gas bills?
Me
My landlord
My tenant
Do you receive any discounted rates on your electric and/or gas bills?*
Yes
No
Not Sure
Do you receive fuel assistance to help pay for your winter monthly heating costs?*
Yes
No
Not Sure
Do you receive any of the following benefits? (Please click