Does Your Home Qualify? - ACIS Energy, LLC

Please fill out the following questionnaire in order to find out if your home qualifies for one the Residential and Hard-To-Reach Standard Offer Programs in which ACIS Energy is a project sponsor.

YOUR INCOME DOES NOT FACTOR INTO THIS PROGRAM.

Once you submit the questionnaire and if your home qualifies, a ACIS Energy representative will contact you in order to schedule an appointment for a Home Evaluation.

Please be aware that if your home has already received any “no cost services” from one of these programs within the past 10 years, your home will not qualify.

Fields marked with * are required

Who is your current Electric Company? *

If you selected "Other," please state which company:

How old is your home? *

Type of Home: *

Please complete the contact information requested below

Please list the property address, no P.O. boxes or mailing addresses.

Name of Home Owner or Renter *

Email of Home Owner or Renter *

Contact Phone Number *

Would you give us permission to send you text messages in for scheduling if needed? *

Name of a secondary contact we can reach out to (Spouse, Roommate, etc.) *

Contact Phone Number for Secondary Contact *

Property Address:

Address Line 1 *

Address Line 2

City and State *

Zipcode *

The following are essential qualifying questions.

Please answer below

Does your home have Central Air System? *

Is your furnace Electric, Heat Pump, or Gas Powered? *

What is the approximate square footage of your home? *

Are there any holes in your home's windows? *

If answered "Yes," please explain briefly:

Are there any holes in the walls or ceilings of your home? *

If answered "Yes," please explain briefly:

What's the best time to reach you? *

Morning
Afternoon
Evening

What's the best way to reach you? *

Call
Text
Email