Your Name *
Address
Home Number
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Type of Fuel for Heat
Number of Heating Systems
Do you have a well pump?Please select…YesNoPlease select…120 Volts240 VoltsDon't Know
Do you have a sump pump?Please select…YesNo
Number of people living in the home including children?
In an outage, for how long would you need backup power? Please select…YesNo
Do you have a home office?Please select…YesNo
Do you have a media room?Please select…YesNo
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