Residential Energy Usage Evaluation

Complete all sections and accept terms and conditions to ensure proper and prompt payment of rebate. If you need assistance completing the online rebate form, call Linn County REC 319-377-1587 and ask to speak to an Energy Advisor. Residential Energy Usage Review is limited to Linn County REC members who have a residential (11TOD and 12TOD) account.

When responding to items with an age attached, enter how many years it has been installed and round to the nearest year {Example; Clothes Washer Age (purchased new in October 2021) so you would enter 1}.

Member Information

Member First Name

Member Last Name

Member Account Number

Remove dashes and spaces (12-34-567 89) to 123456789

Member Account Type

Member Usage Type

Number of People Living in the Home

Member Address

City

State

Zip Code

Member Phone Number

Member Email

What Concerns or Issues Are You Having With Your Home

Are You Considering Alternative Energy Providers (AEP) Such as Wind or Solar

Residence Information

Year Home was Built

Square Footage of Home

Garage

Garage Heated/Cooled

Additional Structures/Building That Are Heated/Cooled

Exterior Wall Construction

Attic Insulation Type

Depth in Inches

Attic Access

Insulated?

Bath Fans

Exterior Wall Insulation

Exterior Material

Foundation

Rim Joist Insulated

Foundation Insulated

Window Glass Type

Window Frame Material

Window Style

Age of Windows

Number of Windows in Home

Number of Exterior Doors in Home

Exterior Door Material

Storm Doors

Weather-stripping/Door Sweeps

Are Your Experiencing Drafts Around Your Window and/or Doors (not including heat or cold from the window glass itself)

Page 2

When responding to items with an age attached, enter how many years it has been installed and round to the nearest year {Example; Clothes Washer Age (purchased new in October 2021) so you would enter 1}.

Heating / Cooling Systems

Primary Heating System

Furnace/Boiler Type

Age of Heating System

Heating System Maintenance

Filter Changes

Secondary Heating System

Secondary Heating System Type

Age of Secondary Heating System

Cooling System

Number of Units

Age of Cooling System

Efficiency

Cooling System Maintenance

Thermostat

Heating Temp

Cooling Temp

Do You Set Back Your Thermostat at Night or When Away

Water Heater

Number of WH in Home

Age of WH

Appliances / Electrical Equipment

Refrigerator Number

Refrigerator Age

Freezer (seperate) Number

Freezer Age

Dishwasher

Age

Stove

Stove Age

Microwave

Clothes Washer Age

Clothes Dryer

Clothes Dryer Age

Electric Blankets #

Space Heaters #

Computers/Laptops

Game Consoles/Computers

TVs #

Hot Tub

Hot Tub Age

Pool

Pool Heater

Well Pump

Motor HP

Heat Tape (Roof/Plumbing)

Animal Water Heaters

Dehumidifier

Age

Humidifier

Age

Battery Chargers

Engine Block Heaters

Heated Concrete

Program

Record Type ID

Page 3

Lighting

LED %

CFL %

Incandescent %

Florescent %

HID %

Electric Vehicle

Does Your Home Currently Have an EV Charger Installed

How Many EV Chargers

Do You Have an Electric Vehicle or Plug in Hybrid

How Many EV or Plug in Hybrid

Manufacturer

Model

Ex - Model 3 Long Range AWD Performance

Manufacturer Year

Estimated Miles per Year

Percent you Charge at Home

Ex - 75

Manufacturer (2)

Model (2)

Ex- Model 3 Long Range AWD Performance

Manufacturer Year (2)

Estimated Miles per Year (2)

Percent you Charge at Home (2)

Ex - 75

Member Agreement

Member agrees that the following was completed to the best of their knowledge. This evaluation will allow Linn County REC employees evaluate members electric usage and give tips on ways to save energy.

Accept Terms and Conditions