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2. Do you have gas service present at this time?
   -- Select One --YesNo
4. If no, are you interested in having natural gas installed?
   -- Select One --YesNo
6. If yes, which of the following appliances do you currently have?

   1. a natural gas heating system
   2. a natural gas fireplace
   3. a natural gas hot water heater

   1. a natural gas range
   2. a natural gas clothes dryer
   3. a natural gas grill

   1. natural gas outdoor lighting
   2. electric central air conditioning
   3. whole house generator
8. If you have natural gas appliances, are you pleased with them?
   -- Select One --YesNo
10. Which of the following appliances are you intersted in having installed in your home?

    1. a natural gas heating system
    2. a natural gas fireplace
    3. a natural gas hot water heater

    1. a natural gas range
    2. a natural gas clothes dryer
    3. a natural gas grill

    1. natural gas outdoor lighting
    2. electric central air conditioning
    3. whole house generator
12. Do you consider natural gas to ba safe energy source?
    -- Select One --No, not at allNot really; it could be saferNot sureYes, it is as safe as any other energyVery safe
14. What is the approximate age of your home?
    -- Select One --0 - 10 years11 - 20 yearsover 20 years
15. What is the approximate value of your home?
    -- Select One --Under $50,000$51,000 - $100,000$101,000 - $150,000Over $150,000
17. To help us make generator need assessments, please answer the following questions:
19. Do you have any medical needs that require electrical service?
    -- Select One --YesNo
21. Does your subdivision have any restrictions that restrict a generator installation?
    -- Select One --YesNo
23. Is access to your property restricted by fences or pets?
    -- Select One --Yes No
25. Name
26. Email
28. Full Address
29. Phone
31. When requesting information from Natural Gas of Milton, rest assured we have appropriate security measures in place to protect against the misuse of information we have collected from you. Thank you for taking time to help us serve you better.
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33. 1. Receive an email copy of this form.
34. Email address

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