Energy Assessment Intake Form

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Please select your language. (Por favor seleccione su idioma.)

Facility Information

Business Name:

Facility Name:

Your facility name might be different from your business name if, for example, your business has more than one location.

Address:

City:

County:

State:

Zip Code:

The Mailing Address for the Facility is:

The same as the Facility addressDifferent than the Facility address

Mailing Address:

City:

State:

Zip Code:

Contact Information:

Principal Contact

First Name:

Last Name:

Email:

Office Phone:

Mobile Phone:

Additional Contact

First Name:

Last Name:

Email:

Office Phone:

Mobile Phone:

Building Information

Primary Heat Source:

Secondary Heat Source:

Primary Water Heater Source:

Secondary Water Heater Source:

Building Type:

Occupancy Type:

Business Type:

Do you know the square footage of your Facility?

YesI have a rough estimateI do not know the square footage (please enter "0" in the next field)

Floor Area (ft2):

For Whatcom, Skagit, and Island Counties, area will determine the cost of the energy assessment.

Number of Buildings:

Building Year Constructed:

Is there any other information about your Facility that we should know about?

Demographic Information

Our program prioritizes serving under-resourced businesses and communities. By providing us with the information below, we will be able to determine how to best serve you.
Note: Please provide information ONLY for the primary business owner.

Is the primary business owner a veteran?

What is the primary business owner's gender?

What is the primary business owner's race?

What is the primary business owner's ethnicity?

What is the primary business owner's Household Annual Median Income?

Does your business have:

Project Information

Do you have a project that you are seeking information about?

Do you already have a contractor estimate?

What types of projects are you interested in?

Hold down Ctrl or Shift on your keyboard while clicking choices to select more than one.

If other, what types of projects?

Additional Information

How did you hear about us?

Are you interested in receiving updates on special offers, news, and events from the Community Energy Challenge?

Yes!Not as this time

Are you interested in receiving a waste assessment for your business? *Only available for businesses in Whatcom County.

Yes!Not at this time

Contact Information