Geo$ense Energy Evaluation: Geothermal Heating and Cooling

To determine what the cost would be to heat and cool your home with the ECONAR GeoSource Heat Pump, complete and submit the following e-mail form. ECONAR will conduct a free energy evaluation comparison of your home. Our response will be sent to you via e-mail or U.S. Mail.

Your Information:
Name:
Address:
City:
State/Prov:
ZIP/Postal:
E-mail:
Phone:

Section A) Load Estimating:
If you know the BTUH requirements of your home fill in below and skip to Section B.
Heat Loss:	BTUH
Heat Gain:	BTUH
If you do not know the BTUH requirements of your home continue here...

Orientation and Dimensional Data
Below are three basic shapes depicting the number of walls exposed to the outside.

For your home, what direction does wall #1 face? N E S W

What best describes your home's foundation?

		slab on grade						unheated crawlspace
		walkout basement						full basement

Using one of the diagrams above, fill in the length and height of exterior walls in feet:
			1	2	3	4	5	6	7	8
	Length:
	Height:

Using one of the diagrams above, fill in the length and height of below grade walls in feet:
			1	2	3	4	5	6	7	8
	Length:
	Height:

Using one of the diagrams above, fill in the total square footage of window area of each wall:
			1	2	3	4	5	6	7	8
	Area:
Area = width x height (if measured in inches multiply width times height and divide by 144)

Using one of the diagrams above, fill in the total square footage of door area of each wall:
			1	2	3	4	5	6	7	8
	Area:
Area = width x height (if measured in inches multiply width times height and divide by 144)

Square Footage
What is the total square footage (LxW) of your Basement?:		Height:
What is the total square footage (LxW) of your Main Level?:		Height:
What is the total square footage (LxW) of your Upper Level 1?:		Height:
What is the total square footage (LxW) of your Upper Level 2?:		Height:

R-Values
What is the R-Value of your Exterior Walls?:
What is the R-Value of your Attic?:
What is the R-Value of your Crawl Space?:
What is your most common type of Window?: Single Double Triple Pane
What is your most common type of Exterior Door?: Wood Steel
What is your most common type of Exterior Wall?: Wood Brick/Stucco Vinyl/Steel
Does your home have a Vapor Barrier?: Yes No

Ventilation
Enter the number of Kitchen and Bath fans:
Enter the number of Fireplaces in your home:
If an Energy Recovery Unit is installed, enter its CFM:		% EFF:

Section B) Utility Information

Name of your Electric Power Company:

City of your Electric Power Company:

Enter Electric Rates in this format: $0.07
Enter its Standard electric rates for: Summer: $ /kWh Winter: $ /kWh

Enter its GeoExchange* electric rates for: Summer: $ /kWh Winter: $ /kWh

What type of Fossil Fuel would be used if GeoExchange were not used? (select one and list its rate):

	Natural Gas: $ /Therm.	Fuel oil: $ /Gal
	LP (Propane) gas: $ /Gal	Elect. resistance: $ /kWh

*Many power suppliers offer special rates for GeoExchange heating and cooling systems.


Section C) Equipment Information:

Enter the Fossil Fuel System efficiency: %						&/or its age: yrs
Enter your Air Conditioner's efficiency: EER (Typically 8-10)						&/or its age: yrs
Enter your Water Heater type: Gas Electric Fuel Oil
Enter the number of People in your home:

Section D) Comments:

Enter any comments that you feel we should know in order to process a more accurate energy evaluation of your home:

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