Does your home qualify? - ACIS Energy, LLC

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

YOUR INCOME DOES NOT FACTOR INTO THESE PROGRAMS.

Once you submit the questionnaire, one of our ACIS representatives will contact you if your home qualifies in order to schedule an appointment for a Home Evaluation.

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

Who is your Electric/Power Company

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

How old is your home?

What to a

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:

First

Last

Email of Home owner or renter:

Contact Phone Number:

Would you like to give us permission to send you text messages for scheduling, if needed?

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

If none, please write "N/A."

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 to the best of your ability.

Does your home have a 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 is the best time to contact you?

Morning
Afternoon
Evening

What is the best way to contact you?

Call
Text
Email