Contact Michigan Energy

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Name

Address1

City

State

Zip

Phone

Fax

Avg. Energy Costs per Month:

Employment Status

Sq. Footage of home

Style of Home

When were your windows installed

When was your roof last worked on

When was the attic insulation installed

When was the wall insulation installed

When was siding installed

When was your furnace installed

Do you have central air

Yes No

Do you have a digital thermostat

Yes No

Is financial assistance needed

Yes No

Any other information you would like to provide