*Phone Number: *Email Address: *Date: 1. What do you hope to accomplish with this project?: 2. What ideas do you have?: 3. How long have you lived here?: 1-3 Years 4-7 Years 8-10 Years 10+ Years 4. How long do you plan to remain?: 1-3 Years 4-7 Years 8-10 Years 10+ Years 5. Do you have any future projects planned?: Yes No 6. At what temperature are you most comfortable?: Below 70 Degrees 70-75 Degrees 75+ Degrees 7. Are you aware of any utility rebates and tax credits for specific equipment?: Yes No 8. Do you think you pay more than average utility bills per month?: Yes No 9. Does your equipment constantly run but does not seem to keep up or takes a long time to reach the desired temperature?: Yes No 10. Is your current equipment load or noisy?: Yes No 11. Do you have constantly uncomfortable areas, i.e., specific rooms or always warm and/or always cold areas? Are there any areas that are muggy or drafty?: Yes No 12. Does your home have wall and attic insulation?: Yes No 13. Are you interested in reducing or eliminating dust/and or odors in the home?: Yes No 14. How does your existing system perform on the hottest and coldest days of the year?: I am happy with the performance It needs some attention 15. Would you like to understand more about indoor air quality issues such as mold, mildew, bacteria, etc.?: Yes No 16. Do you have carbon monoxide detectors in your home?: Yes No 17. Do you know they need to be replaced every 3 – 5 years?: Yes No 18. Do you run a business out of the house or do a lot of entertaining?: Yes No 19. How many people are typically in the home at one time?: 1 2-4 5+ 20. Do you do a lot of cooking, or do any catering?: Yes No 21. Is there an older person or someone in the home that has special needs? (i.e. a warmer room): Yes No 22. Is there anyone in the home who suffers from respiratory problems such as COP, asthma, etc.?: Yes No 23. Are there any special humification requirements? (Antiques, artwork, etc.): Yes No Is there anything that we should know about that we did not cover with the survey?:
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