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Recorded Line:
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First Name:
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Last Name:
Phone:
Average Utility bill amount (Number):
Current Utility Provider:
Home Type:
Single Family Home
Condo/Townhome
Duplex
Address:
City:
State:
Zip Code:
Roof Type:
Asphalt
Metal
Slate
Tile
Wood
Corrugated Metal (DQ)
Roof Condition:
Shading Problems:
Yes
No
How long have you lived in the home?:
Spouse (Title) name:
Is your credit Score above 650?:
Yes
No
Not Sure
BK, Leins, Judgements?:
BK
Judgements
Leins
N/A
Computer Access:
Yes
No
Email:
Comments:
Solar Consultation Date:
Solar Consultation Time:
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Partner Email address: