miPower Participant Questionnaire

Report
*Member Name	Please enter the members name
*Service Address	Please enter service address
*Member Phone	Please enter a phone number
*E-mail Address	Please enter your email address
Number of A/C Units	How many A/C Units do you have.
Gas Heat?	Are your heaters Gas?
Programmable Thermostat?	Are your Thermostats programmable?
Number of Water Heaters	How many Water Heaters do you have.
Gas Water Heaters?	Are your Water Heaters Gas?
Age of Home	What is the age of your home?
Comments	Is there any other information you would like to provide?