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2. I am interested in an energy assessment of my:*

   1. Home
   2. Small business
4. First Name of Account Holder*
5. Last Name*
7. Nantucket Property Address*
9. Own or Rent?*
   -- Select One --OwnRent
11. National Grid Account #?*
13. Contact Phone Number*
15. Contact Email*
17. Primary Heating Fuel*
    -- Select One --PropaneOilElectric heatWood stoveGeothermalSolarOther
19. Do you have central air-conditioning?*
    -- Select One --YesNo
21. Do you receive a low-income electric rate (R-2) or fuel assistance?*
    -- Select One --YesNo
23. Style of Home/Building*
    -- Select One --CapeSaltboxRanchUpside-down houseColonialPost & beamCottageGambrel CathedralGarage apt.Smal businessOther
25. Year Home/Building was Built*
27. # of Units in House*
    -- Select One --Single family homeDuplex: condo or multifamilySmall business or Inn3 units: Condo or multi-family4 units: Condo or multi-family5+ units: Condo or multi-family
29. How did you hear about the Mass Save Program?*
31. Any additional comments or particular information we should know about your home or your availability?*
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33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field