Do You Qualify First Name Last Name Your Email Phone Number Home Address City Zip Code Do You Own Your Home? —Please choose an option—YesNo What Is Your Average Monthly Electric Bill? —Please choose an option—Under $100$100-$200$200-$300$300-$400+$400 How Old Is Your Roof? —Please choose an option—1 Year5 Years10 Years15+ Years How Much Sun Does Your Roof Get? —Please choose an option—Full SunPartial SunNo Sun Please prove you are human by selecting the car.