First Name *

Last Name *

Phone *

Email *

Address

Street Address *

City *

State *

Postal Code *

Are you a Homeowner or a Renter? *

Homeowner

Renter

Owner’s First Name *

Owner’s Last Name *

Owner's Phone *

Owner’s Email *

Do you currently live in this home? *

Yes

No

What type of home is it? *

Single family

Mobile home

Multi Family

Other

How many people live in your household? *

How many of those are 18 or older with income? *

What is your monthly household gross income? *

$

⚠️ Enter your actual household income, never $0. If retired or not working, include Social Security, pension, disability, or other benefits. Report income for all members over 18 with income.

Who is your electric utility provider? *

Please specify the name of your electric provider *

Electric account number *

Duke Account First Name *

Duke Account Last Name *

Duke Account Number *

What is your primary heating fuel? *

Propane (LP) Provider *

Heating Oil Provider *

Gas Provider *

Select the unit of Measurement of your natural gas bills *

Your Signatures *

Clear

I have read and agree to the ESNC Consent Form, including the User Consent, Attestation, and all applicable program terms and conditions.