Cape Save Home Energy Assessment Request Form

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 #

National Grid Account Name & Account Number #

How did you hear about Cape Save?

Referral Contact Info (if applicable)

Have you registered in the Mass Save program before?

Yes

No

Yes, but not at this address

Do you have a single family home?

Yes

No

Do you own or rent?

Own

Rent

What is the style of your home?

What is your primary heating fuel?

Natural Gas

Electric

Other

Does the home have central air conditioning?

Yes

No

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.