HOUSE CALL REQUEST FORM & PRE-AUDIT QUESTIONNAIRE
I request a: Standard House Call ($300 value for a co-pay of $50)
Performance House Call ($380 value for a co-pay of $125)
The audit takes about two hours. Our qualiﬁed energy auditor will call you to schedule your audit at a time when you can be present.
CUSTOMER & RESIDENCE INFORMATION
Street Address: ___________________________________________________________________________________
City / State / Zip: __________________________________________________________________________________
Austin or Owatonna Utilities services: Electric Natural Gas Water
Utility Account Number: _________________________________________________
Day Phone: (__________) _________________________ Evening Phone: (__________) _________________________
Best time to contact me: Morning Evening Anytime
Type of Home: Single-family Multi-family Owner-Occupied Rental (# of units: __________)
How many years have you lived at this residence? ___________
Year Residence Was Built: ____________________
Number of Stories: 1 1.5 2 Other __________
Total Sq. Ft. (including basement): ___________
SIGNATURE & RELEASE FOR ENERGY DATA
By signing this waiver, you’re allowing your utility company, Austin Utilities or Owatonna Public Utilities, to provide your utility usage
information and Home Energy Report (if applicable) to partners with whom they have data conﬁdentiality agreements for the purpose
of completing your CONSERVE & SAVE House Call, as well as for conducting program evaluation.
Signature: _______________________________________________________ Date: ___________________________
Pre-Audit Questionnaire continued on back...
click to sign
click to edit