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508-398-0398

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Cape Save Home Energy Assessment Request

Referred by: Amy Hohmann, Today Real Estate

First name*

Last name*

Email*

Phone*

Home Address (Street, City, Zip Code) for the house you want to register*

Utility Accounts & Referrals

Eversource Account Name and Account Number #*

Please provide your Eversource account # and the name on the account (e.g. John Smith - 1400001234). This information must be provided to register.

National Grid Account Name & Account Number #

Please provide your National Grid account name and number (e.g. John F. Smith - 55000-12000) This information must be provided to register if you have a natural gas heating system.

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.*

Use your mouse to sign in the box above.

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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