| Name * | |
| Email Address * | |
| Street Address | |
| Suburb | |
| State * | ACT NSW NT QLD SA TAS VIC WA International (outside of Australia) |
| Postcode * | |
| Country * | |
| (Change if not Australia) | |
| Daytime Contact Number * | |
| Are you considering solar for environmental reasons? | No Yes |
| Are you considering solar to reduce energy consumption? | No Yes |
| No. of bedrooms | |
| No. of bathrooms | |
| Do you have a spa? | No Yes |
| If so, for how many people? | |
| What activities might increase your hot water consumption? | |
| What hot water system are you currently using? | Electric Storage Gas Storage Gas Instantaneous Solar (electricity) Solar (gas) Other |
| Electricity Tariff | Off-Peak Continuous |
| Gas Tariff | Natural LPG |
| What capacity model are you currently using? | |
| Is your current system adequate? | No Yes |
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