First: Last:
Street: City: State: Zip:
Phone: Email:
Ownership: OwnRent
Electric Bill: $0-50$51-100$101-150$151-200$201-300$301-400$401-500$501-600$601-700$701-800$801+ Electricity Provider:
Roof Shade: No ShadeA Little Shade A Lot of ShadeUncertain