* Required field Please add your name and service address as it appears on your bill. First Name Last Name Address Address Line 1 Address Line 2 City State ZIP Code Email Phone Number Account Number Do you participate in any of the following assistance programs? SNAP LIHEAP WIC Welfare Section Other assistance programs What is your household size? What is your household income? What type of home do you have? Single family Apartment Manufactured home What type of fuel do you use to heat your home? Electric Gas Propane Other What type of fuel do you use for water heating? Electric Gas Propane Other What year was your home built? What is your home’s square footage? Do you currently have a smart thermostat? Yes No Which energy-saving products would you like to receive at no charge? Smart thermostat Kitchen faucet aerator Bath faucet aerator Showerhead Window and door weatherstripping Door sweep
