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Audit Request – Free Program
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Audit Request – Free Program
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Participating in the UGI Free Program?
Yes
UGI Save Smart WARM Home Energy Upgrades Program Application
Contact Information
Name
*
Required
First
Last
Phone
*
Required
Email
*
Required
Preferred Method of Contact
*
Required
Phone
Email
No preference
When would you like us to contact you?
*
Required
Early Morning, 7-9 AM
Morning, 9 AM-Noon
Afternoon, Noon-4 PM
Evening, 4-8 PM
Service Address
*
Required
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
How did you hear about the Home Energy Upgrades program?
*
Required
UGI E-mail
UGI Postcard
UGI Bill
Magazine
Radio Ad
Online/Social Media Ad
Word of Mouth
Home Details
Main Heating Type
*
Required
- Select -
Natural Gas Furnace
Natural Gas Boiler
Other Gas Heater
Heating must use gas fuel.
Does your home have multiple furnaces or boilers?
*
Required
- Select -
Yes
No
Unsure
Water Heater Fuel
*
Required
- Select -
Natural Gas
Electric
Other
Unsure
Thermostat Type
*
Required
- Select -
Programmable
Non-Programmable
Unsure
Are you interested in *receiving a smart wi-fi thermostat during the home energy evaluation?
*
Required
- Select -
Yes, please tell me more
No, not currently interested
I already have one
*IF HOME WIRING NEEDS TO BE UPGRADED TO INSTALL THE SMART THERMOSTAT, THE THERMOSTAT WILL NOT BE INSTALLED OR CONTRACTOR MAY CHARGE THEIR MARKET RATE TO MAKE THE NECESSARY UPGRADE.
Additional Details (not required, but helpful)
Year Built
Conditioned Area, sq. ft. (estimated)
Optional Comments
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