Green House Call Interest Form
Please select your preferred language.
Contact Information
First Name
Last Name
Email
Phone Number (ex: 123456790)
Preferred Contact Method
Please select...
Text
Call
Email
No Preference
By checking this box, you agree to receive text messages related to the Green House Call program.
Message and data rates may apply.
I agree
Last Name Helper
Preferred Language
Please select...
English
Chinese (unspecified)
Spanish
Vietnamese
Mandarin
Cantonese
Tagalog
Other
If Other, Please Specify
Residential Information
Residential Street Address
e.g. 123 Main St
Residential Unit/Apt Number
e.g. Apt 1
City of Residence
Zip Code of Residence
City Helper
County of Residence
Please select...
Alameda
Contra Costa
Madera
Marin
Merced
Napa
San Francisco
San Joaquin
San Mateo
Santa Clara
Solano
Sonoma
County of Residence Not Listed
State of Residence
Hidden Helper Fields
Residential Street Address Helper - House Number only
Residential Street Address Helper - House Number + First letter of next word
Residential Street Address Helper - House Number + next word
Complete residential Street Address
(please ensure that your selection includes your apartment or unit number)
If you do not see your address, please check that you inputted the street number and city correctly. Also, please given this field some time to load. It is searching through a large database of addresses.
If you are
UNABLE
to find your
COMPLETE
residential street address, please check the box below:
I am unable to find my complete residential street address
Household Information
What type of house do you reside in?
Please select...
Single Family Dwelling
Multi-Family Dwelling
2-4 Plex
Mobile/Manufactured Home
Military housing
Which best describe the residence? (Select all that apply)
Built before 2008
Built after 2008
Retrofitted since 2008 to meet Title 24 standards
In the past four years, has your home been modified under any of the following energy efficiency programs? (Select all that apply)
Low-Income Weatherization Program (LIWP)
Low-Income Home Energy Assistance Program (LIHEAP)
Department of Energy (DOE) federal programs
Another organization or company has performed significant energy efficiency upgrades
None of the above apply to my current residence
How many people currently live in the home?
What is your annual gross household income?
Event Information
Where did you first hear about our program?
Please select...
Mailed Letter/Postcard from County
Mailed Letter/Postcard from City
Mailed Letter/Postcard from Rising Sun
Rising Sun Website or Social Media
Social Media Ad: Facebook or Instagram
County or City Website or Social Media
County Newsletter/Email
City Newsletter/Email
Referral from a friend, family member, or other acquaintance
Tabling from a Community event
BayREN presentation (online or in person)
Nextdoor
Peachjar
GRID Alternatives
Marine Mammal Center
Online Advertisement
Empower Solano
Other
Date of Event
Event Name
Date Helper Field
Additional Notes
Contact vs Lead
Contact Information