Home Assessment
Note that answers are not required for all questions but the more information you can provide the better we can assess if your home is a good fit.
Name
*
First Name
Last Name
Email
*
example@example.com
Do you have a well?
*
Yes
No
What are the reasons you're considering a Well-Connect for your home? (select all that apply)
*
Save money on heating costs
Add air conditioning
Eliminate burning wood or wood pellets
Reduce fossil fuel emissions
Upgrade heating/cooling system to improve home's value and extend life of existing furnace
Other
Your Home's current heating energy source (select all that apply)
*
Propane
Fuel Oil
Natural Gas
Electric Resistance
Wood - outdoor wood boiler or wood furnace
Wood - wood stove in living area
Pellets
Air Source Heat Pump
Geothermal
Electric Space Heater(s)
Approximately how much of your current fuel source do you use annually? (example: gallons of propane or fuel oil, cords of wood, etc. ). If you heat with a combination of sources, such as propane plus wood, please identify how much of each source you use. We want to know your total energy requirement for heating in order to choose the ideal model Well-Connect for you.
Home's current heating distribution system
*
Forced Air
Baseboard
Radiant Floor
Other
Home's Foundation
*
Basement
Crawl
Slab
Approximate square footage of home (heated space)
*
Who is your electrical utility provider?
There is a Federal Tax Credit available to homeowners who install a geothermal system in their home. This credit is 30% of the total cost of the installed system for the next 12 years. It is a credit against your income tax liability, therefore you have to be paying income tax to qualify for this credit. Do you pay income taxes and believe you would qualify for this credit?
Yes
No
Unsure (I need to talk to my tax advisor)
Submit
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