Natural Gas Extension Survey

 

Name_________________________________________________(please print)

SERVICE ADDRESS____________________________________

 

____________________________________________________________________________________________

Home Phone # ______________________________

Work Phone # ______________________________

Signature__________________________________

 

1. I own this house.     I rent this house.

 

2. My existing heating system is:

    Central Electric     Heat Pump     Central Oil     Central LP (Liquid Propane)

    Central     Strip     Electric     Resistance     Non-Central LP

3. My existing heating system is           years old.

4. My existing water heater is:

    Electric     Oil     Liquid     Propane     Other

5. If natural gas mains are extended on my street, and the City offers a $450.00 gas water heater rebate, I           would consider replacing my existing water heater with a new natural gas water heater.

    Yes     No

6. Also, I would consider switching my home heating system to central natural gas.

    Yes     No

7. Check if applicable. I would consider changing or adding the following natural gas appliances:

    Water     Heater     Furnace     Range     Clothes     Dryer

    Gas     Fire     Logs     Grill     Other

8. I am not interested in connecting to City natural gas.

 

Thank you for taking the time to complete this survey!