UPGRADE TO SAVE ENROLLMENT FORM

First Name

As it appears on the Roanoke Electric account

Last Name

As it appears on the Roanoke Electric account

Name of other person on the account (if applicable)

Number of Occupants

Service Address

Service City

Service State

Service Zip Code

Service County

Mailing Address

If mailing address is different from property address, enter the mailing address below.

Mailing City

Mailing State

Mailing Zip Code

Mobile Phone Number

Other Phone Number

Other Phone Type

Property Ownership

Own

Rent

Home sqft

Please enter the number of square feet of your home only. (numbers only field) Example - 1860

What year was your home built or manufactured?

How do you primarily cool your home?

Central Air

Window Units

Ceiling Fans

None

Do you use propane, natural gas, oil, kerosene, and/or wood?

If the primary source of heat is one of these, enter the average dollar amount you pay each year. Example: $1,000 propane (you will need to provide annual fuel history documentation to substantiate this cost at the time of house visit)

How many central heating and cooling systems do you have?

None

If you have a central heating and cooling system, is it operational?

If you have a second heating source, what is this heating source?

Secondary Heating Type

Do you have any of the below that is on the same meter. If so, pick the one that is used the most.

Is your home currently under renovation with missing ceilings/flooring/walls/windows

Yes

Do you have internet service in your home today?

Yes

Would you like to learn more about internet service by Roanoke Connect?

Yes

Which of the following influenced you the most to sign up for the Upgrade to Save Program?

Participants Open Availability

Would you like to volunteer to be on our standby call list for cancellations and unexpected openings in order to get ahead of our assessment backlog? If so, select the best option below.

Have you ever received assistance from CADA (Choanoke Area Development Association) or EIC (Economic Improvement Council)?

Yes

Comments

Enter any kind of special notes here

Release of Energy Usage

To establish a baseline from which to evaluate my home's potential for energy savings through Roanoke Electric Cooperative's Upgrade To Save Program, you understand and consent to share past and present energy use from your home with all affiliated implementers, assessors, and contractors, to access solely and strictly in support of the program. By answering "Yes" below you are giving consent.

Yes

Submitted By

Participant, Friend/Family of Participant, EEtility Staff , REC Staff, NCSEA Staff. (If you are an REC, EEtility or NCSEA Staff member please us the following example format: REC Staff - First & Last Name)

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