DSB Energy Services Customer Questionnaire Thank you for choosing DSB Energy Services LLC for your home performance audit. Please take a few minutes and fil out this form as completely as you can. This information will enable us to better understand comfort issues in your home as well as more accurately model the energy and water usage in your home. This will make our energy assessment more accurate. Homeowner Information Full Name ____________________________ Phone Number ____________________ Address _______________________________________________________________ Street Address City State Zip Electric Utility _________________________ Account # ________________________ Gas Utility ____________________________ Account # ________________________ Reason for requesting an energy audit? Please rank from one to three in order of importance. ___ Reduced energy bills ____ Increased comfort ____ Environmental Residency How long have you lived at the home? ______________________________________ What is the approximate age of the home? ___________________________________ How many people live in the home full-time? __________ Seasonally? ____________ Have you remodeled, upgraded or added to home? ______ If so, what was done and when? Page 1 of 5 Health Does anyone suffer from ...