Energy Evaluation

Contact Info

Name*

If you are not a VGS customer, please check out Efficiency Vermont at https://www.efficiencyvermont.com/homeperformance

Daytime Phone Number*

Email Address*

Owner's Name

Property Info

Heated square footage*

Number of occupants*

Year home built*

What type of home do you have?*

Single Family House Detail*

Number of Units

If not sure/other please describe

Heating & Cooling Systems

How old is your heating system?*

What type of heating source?*

How much of this heating source do you use annually?*

Improvement Goals

Any other reasons for an energy evaluation?

How motivated are you to move forward with improvements on your home in the next 6 months?*

What company provided the energy audit or quote?

Project Funding

Number of People in Household	1	2	3	4	5	6+
Chittenden & Franklin Counties	$95,600	$109,200	$122,800	$136,400	$147,400	$161,100
Addison County	$83,200	$95,100	$107,000	$118,900	$128,500	$138,000

Income is defined as the total annual gross income of all family and non-family members 18+ years old living within the household. To calculate income, take the monthly amount from the last one-to-two paychecks for yourself and the people in your household (before taxes) and multiply by 12. Include all wages, including regular salaries and overtime. If you are self-employed, use the previous month of pretax income and multiply by 12.

All sources of income must be counted from all persons in the household based on anticipated income expected within the next 12 months. Possible types of income include but are not limited to: wages, salary, tips, bonuses or commissions payments, public assistance, social security/SSI, child support, regular gifts, unemployment, income earned on assets (savings, IRA, etc.) and some types of financial aid.

Type your name to sign consent*

Date

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