Are you the homeowner ? *

Yes

No

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

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How much do you estimate you are spending montly on your electric bill ?

under $50

$50-$100

$100-$150

$150-$200

over $200

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Yes , I Agree