Make Mine Solar H20 Sign Up Form

Please complete and submit the form below to show your interest in participating in our solar thermal bulk purchase program "Make Mine Solar H20"

MRES respects your privacy and will not share your contact information outside of our organization.

About You

Name: *

Company:

Address: *

City: *

Neighborhood: *

Ex: (Hiawatha, Seward, Mac Groveland)

State: * select...ALAKASAZARCACOCTDEDCFMFLGAGUHIIDILINIAKSKYLAMEMHMDMAMIMNMSMOMTNENVNHNJNMNYNCNDMPOHOKORPWPAPRRISCSDTNTXUTVTVIVAWAWVWIWY

Zip: *

Phone:

E-mail: *

Are you aware that if your roof needs to be replaced sometimes the system needs to be re-installed at your expense?: *

Yes

No

(ie if your roof is close to needing to be replaced you may want to replace it before installation)

Are you willing to help promote this program to your neighbors?: *

Yes

No

(Please forward www.makeminesolar.org to someone! The more people that participate the bigger the bulk discount!)

Are you willing to join the MN Energy Challenge and be on our Team?: *

Yes

No

Are you willing to pay $90 for a Solar Site Assessment?: *

Yes

No

Do you rent or own?: *

Rent

Own

Is this a home or a business?: *

Home

Business

Are you a member of MRES?: *

Yes

No, but I might be interested in joining in the future.

No, and I am not interested in joining.

Would you like to receive our monthly newsletter, the Solar Flare?: *

Yes

No

How did you hear about this program?:

How many people currently use the water in the building/house full time?: *

Comments/Questions

I have a question or comment::