Last Name:
First Name:
Street Address:
Home Phone Number:
E-mail address:
Where did you learn about Solar Home Energy Solutions?

Home Owner Goal(s):

I/we want to: Reduce our Energy bill
  Take advantage of NJ Rebate Program
  Create "Green Power" and reduce pollution
With the money I/we save from lowering our Electric bill, I/we plan to: Invest in other energy saving natural gas appliances, windows, insulation, etc.
  Pay off other loans/bills
  Increase monthly savings for (College, Retirement, etc.)
If a Solar Solution can meet your needs, when would you want your installation?

Home Information:

I/we have lived in our home for: years
Approximate age of your home:
How many bedrooms?
How many bathrooms?
Our home is a:
Approximately how old is your roof?
What general direction does your roof face?
What percentage of your roof is shaded by tree on your property?
Are you willing to cut down trees that shade your roof?
Are there parts of your roof shaded by trees / structures that are not on your property?
From your most recent electric portion of your Energy Bill: Monthly dollar amount charges for only electricity:
Amount of electricity your home used:
How many years of Energy Bills we have to refer to for estimating our electric energy use?
Best day of the week and times to contact us:

Moorestown, NJ • (856) 255 - 5727