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RECAP Application
First Name
Last Name
Phone Number
Email
Street Address
City
State
Zip Code
Do you currently have solar?
Yes
No
Do you still have a True-Up bill?
Yes
No
How much was your True-Up bill for the year?
less than $500
$500 - $1000
$1000 - $2000
more than $2000
What is your average monthly electric bill?
Do you have an electric vehicle?
Yes
No
Do you plan to get an electric vehicle?
Yes
No
Do you or a family member living with you have any of the following medical conditions:
Arthritis, Asthma, Autonomic Neuropathy, Congestive Heart Failure, COPD, Cystic Fibrosis, Eczema, Fibromyalgia, Heart Condition, Hyperthyroidism, Life-threatening illness or compromised immune system. Requires heating and/or cooling to sustain life or prevent medical deterioration, Lyme Disease, Migraines, Motorized Wheelchair, Multiple sclerosis, Muscle Spasms and Cramps, Paraplegic, hemiplegic or quadriplegic condition, Raynaud's Syndrome, Scleroderma with heating needs, Sickle Cell Disease, Sleep apnea, 0r any other condition that requires heating or A/C
Yes
No
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