Online form

Please fill the form

    Has there ever been an energy assessment at this address before?
    YesNo

    CLIENT NAME

    PHONE NUMBER:

    ADDRESS:

    ELECTRIC COMPANY:

    ACCOUNT #:

    GAS COMPANY:

    ACCOUNT#:

    EMAIL ADDRESS:

    ARE THERE ANY SPECIFIC CONCERNS WITH YOUR HOME THAT THE TECHNICIAN SHOULD ADDRESS?:

    HEATING FUEL TYPE:

    TYPE OF HEAT:

    STYLE OF HOME:

    AGE (YEAR BUILT):

    SQUARE FOOTAGE:

    CENTRAL AIR?
    YesNo

    FINISHED BASEMENT?
    YesNo

    IS ATTIC USED FOR STORAGE?
    YesNo

    FIREPLACE/WOODSTOVE?
    YesNo

    ANY KNOWN ASBESTOS IN HOME?
    YesNo

    ANY KNOWN MOLD IN HOME?
    YesNo

    ANY ONGOING CONTRUCTION IN HOME/ANY PLANNED BEFORE AUDIT?
    YesNo

    Please note

    Important info:

    We will contact you several days in advance to confirm the assessment appointment. If there are any changes or if you have any questions, please contact us at 860-589-8979 or email info@sealaduct.com.

    Please make sure no one uses any woodstoves or fireplaces at least 24 hours prior to your appointment, otherwise it will compromise the accuracy of the blower door test.

    We cannot perform efficiency evaluation tests if there is any ongoing construction in the unit that requires exposed or openings in the exterior walls.