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Cape Save & Cape Cod Heat Pumps Mass Save Registration Form

First name*

Last name*

Email*

Cell Phone*

Street Address of the property you are registering*

City/Town*

Zip Code*

Zip Code of the property you are registering

Utility Accounts & Referrals

Eversource Account Name and Account Number #*

Please enter the Eversource electricity account holder's name and account number (e.g. John Smith 7400101234).

This information must be provided to register.

For homes heated by natural gas: National Grid Account Info

Please enter the National Grid natural gas account holder's name and account number (e.g. John Smith 55123-00012).

This information must be provided to register.

Name of the Cape Cod Heat Pumps representative you are working with:*

What is Cape Cod Heat Pumps doing for you?

Provide a short description of the work CCHP is doing at your property.

Have you registered in the Mass Save program before?

Yes

Yes, but not at this address

About Your Home

Do you have a single family home?*

Yes

Do you own or rent?*

Own

Rent

What is your household size?***

4 or more

What is your income level?

Less than $50,000

$50,000 - $69,999

$70,000 - $85,999

$86,000 - $99,999

$100,000 or more

***We ask the previous two questions to help determine if you are eligible for income-based assistance that could cover weatherization improvements at 100%.

What is the style of your home?*

Cape

Ranch

Cottage

Colonial

Modern

Contemporary

Other

What is your primary heating fuel?*

Natural Gas

Electric

Other

Does the home have central air conditioning?*

Yes

In what year was the home built?*

What is the approximate square footage of the house?*

Please sign to indicate you would like a free Home Energy Assessment in the Mass Save® program.*

Signature field is empty.

Use your mouse to sign in the box above.

Would you like to receive an email newsletter from us in the future?

If you have any questions, please call or text 508-398-0398 or email info@capesave.com

info@capesave.com

508-398-0398

7-D Huntington Avenue, So. Yarmouth, MA 02664

Fully Licensed & Insured. Certifications: BPI BA-T, Lead-Safe, OSHA

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