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First Name:

Last Name:

Street:

City:

Zip:

Phone:

Email:



What product or products most interest you?
Solar Electric
Wind Power
Micro-Hydro


Will this installation be for:
Home
Business
Farm
School
Government
Other:


Please indicate you average monthly electric bill:
Under $100 $100-200 $201-300 $301-400 over $400


Who is your current electricity provider?



Future solar power system location.

Do you have at least 300 square feet of space (roof, patio covering, etc.)?
Ideal locations should be shade free and facing south.
Yes No Don't know


If yes, please select one of more of the following:
Pitched roof Flat roof Ground space

Does this area or areas face south? Yes No

If no, indicate southern-most sun exposure here:



Your Roof

Will you need a roof replacement within the next two years?
Yes No
Estimated number of years before your roof must be replaced:

When do you require your solar energy system operational?
3 months six months one year unsure


Additional information or comments:


How would you like us to contact you?
Phone call E-mail Postal service


Thank you for your interest in Green Power Solutions. We are here to serve. We will contact you shortly with an in-depth energy analysis which will serve as your blueprint to a brighter energy future.