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Revalue.io Customer Intake Form
Revalue.io is an energy efficiency project development and management company that specializes in renewable energy and building electrification optimizing available financial resources.
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Property Address
*
Your answer
Phone Number
*
Your answer
How did you hear about us?
*
Website
Referral
Publication
Other:
Owner or Tenant?
*
Owner
Tenant
Other:
What kind of home improvements are you interested in?
*
Home health hazards
Energy efficiency
Electrification
Aesthetics
Other:
Required
Are there any planned improvements to the home?
*
Yes
No
Please share your future energy plans for your home. If there are planned improvements, please describe.
Your answer
Have you noticed any of the following home health hazards?
*
Mold
Moisture, smell
Fall hazards
Broken appliances, furnace
Lead
Broken windows, holes in walls, broken doors,
Other:
Required
Have you had an energy audit or home health assessment in the past?
*
Yes
No
Not Sure/Information Unavailable
Are you aware that there may be Energy Efficiency / Electrification Rebates you might qualify for?
*
Yes
No
Does any resident participate in any income, utility cost, housing or food assistance programs?
*
Yes
No
Maybe
Are there any seniors or children under the age of 6 in the home or visit regularly?
*
Yes
No
Both
How do you plan on funding the project?
Cash
Financing
Other:
Clear selection
What are the best days/times to schedule your energy audit?
Your answer
Any additional information you'd like to share about your home improvement interest?
Your answer
Send me a copy of my responses.
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