CMLP Coaching Service Request Form

Your Name *

First Last

Your Email *

Phone Number

Street Address *

I'm interested in... (please check all that apply) *

Replacing a heating or cooling system Adding air conditioning Building a new addition Building a new house Replacing a water heater Other (please specify)

For my... *

Home Business

What step of the process are you at with your heat pump? *

Just beginning to look into heat pumps Starting to meet with contractors Reviewing contracts Signed contracts, planning to install soon Have a recently completed installation

How old is your current heating system?

Does your home currently have central air conditioning?

Yes No

How old is your current AC system?

What can we help you with?

If you were to change your home’s heating/cooling or water heating system, please rate the following decision factors:

	Important (select all that apply)	Most Important (select up to 2)
Adding air conditioning to my house
Reducing my house’s carbon footprint
Minimizing initial cost of installing a new system
Minimizing ongoing energy costs
Minimizing changes to the aesthetics of my home
Other (please specify below)

If you answered "Other" to the question above, please specify:

[DEFUNCT] Is replacing your current home heating/cooling or water-heating system an urgent need because your current system is broken or in need of costly repairs?

Yes No

[DEFUNCT] We often look up buildings online to help visualize them during our conversation. Please share your address, if you’re comfortable.

If you would like to work with a specific coach, please indicate here. We will do our best to accommodate your request given existing workloads.

How did you hear about the coaching service?

The Customer agrees to waive any and all claims against Abode, the Town of Concord and the Concord Municipal Light Plant that may arise out of Abode's consultation with the Customer. Any and all contracts entered into by the Customer are solely between the Customer and their Contractor or Service Provider. *

Agree

We'll let you know within 1 business day that we've assigned your request to a coach.

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