Farm Energy Evaluation Form

If you have a non-farm rural business, and are interested in our programs please email us and tell us about your business and energy usage.

Farm Name

Farm Type (Check all that apply)*

If Farm Type is Other, please describe:

Contact Name*

FirstLast

Physical Address*

Street AddressAddress Line 2City

StateZip Code

Mailing Address (If different)

Street AddressAddress Line 2City

StateZip Code

Phone*

Mobile Phone

Email*

Website

Best time to contact you:

Which types of energy sources do you use? Check all that apply.

For those items you checked above, please tell us approximately how much you use:

Electricity – Average monthly use in dollars

Heating Fuel (Wood) – Annual use in cords

Heating Fuel (Oil) – Annual use in gallons

Heating Fuel (Propane) – Annual use in gallons

Heating (Other) Please be specific – Include type, quantity and units.

Diesel/Gas – Annual use in gallons

Please list and/or describe any other energy consuming farm inputs (such as fertilizers)

Please share any other information you feel is important:

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