First Name     Last Name

Address

City     State

Zip

Telephone Number (include area code)

Customer Number
*If Known*

E-mail address

Your Home

Do you own or rent your own home?    Own    Rent

How many square feet of living space do you have?    Less than 1,200 1,200 - 1,999 2,000 - 2,499 2,500 +  

Approximately when was your home built? Before 1960 1960-1969 1970-1979 1980-1989 1990-1999 After 1999  

Do you have natural gas available to your home?    Yes    No

Which best describes your account?    Single Family Residence Mobile/Modular Home Vacation/Seasonal Home Farm Home Non-Residence  

What fuel does your water heater use?    Electricity Natural Gas Propane/Bottled LP Other  

Approximately what year was your water heater installed?    Before 1985 1985-1989 1990-1994 1995-1999 After 1999  

Your Heating & Cooling System

What is your home's main source of heat?    Electricity Natural Gas Propane/Bottled LP Wood Fuel Oil  

What type of heating system do you have? (check all that apply)
Ground Source Heat Pump
Air Source Heat Pump
Baseboard/Ceiling Cable
Space Heater
Furnace
Central Unit
Other

Approximately when was your heating system installed?    Before 1980 1980-1984 1985-1989 1990-1994 1995-1999 After 1999  

What type of air conditioning system do you have?    Ground Source Heat Pump Air Source Heat Pump Central Air Window Unit Evaporative Cooler None  

Approximately when was your cooling system installed?    Before 1980 1980-1984 1985-1989 1990-1994 1995-1999 After 1999 None  

Other Information

Please mark each of the following you use in your home. (check all that apply)

How many people live in your home?    One Person Two People Three People Four People Five People Six or More People  

Are you presently using these at your home?
Personal Computer
Internet

Which website features are most important to you?

Are you interested in receiving any of these services from  the co-op?

Which radio stations do you most frequently listen to?

What is your age?

Which best describes the occupation of the primary account holder?

Do you plan to build a house in the near future?
Yes, in the next 6 months
Yes, in the next year
Yes, in the next 2 years
No

Cooperative Attitudes

How would you describe your relationship with Heart of Texas County Electric?
Member    Owner    Customer    Rate payer

How would you rate your level of satisfaction with your present electrical service from Heart of Texas Electric Cooperative?
Very dissatisfied    1  2  3  4  5    Very satisfied

At some point in the future, you may have a choice of an electric service provider. Would you be more likely to stay with your electric provider or switch to another provider?
Stay Switch Undecided  

If provided with the option to buy electricity from any supplier, which of the following would you consider most important?
Cost
Service & reliability
Total dollars paid annually
Convenience of a local service