Do You Qualify

First Name

Last Name

Your Email

Phone Number

Home Address

City

Zip Code

Do You Own Your Home?
—Please choose an option—YesNo

What Is Your Average Monthly Electric Bill?
—Please choose an option—Under $100$100-$200$200-$300$300-$400+$400

How Old Is Your Roof?
—Please choose an option—1 Year5 Years10 Years15+ Years

How Much Sun Does Your Roof Get?
—Please choose an option—Full SunPartial SunNo Sun

Prove you are human. Select heart