Referral Request Form

The Power Smart Alliance can help your business find industry members to assist with your energy efficiency projects.


Personal Information
First Name
Last Name
Company Name
Position
Industry
Contact Information
Providing your account number will enable us to serve you more efficiently
Account Number
(optional)
City
Site Address
Preferred Method of contact:
Email: Phone:
Email
Phone
( )
Cell
( )
The best time to phone me is:

Areas of Interest

Please check off the retrofits or services you are interested in:

Controls (heating, cooling, etc.)
System Design
Installation
Recommissioning and optimization

Lighting
System Design
Interior retrofit
Exterior retrofit
     Building (ie. signage)
     Non-building (ie. parkade, roadway)
Electrical

Power Factor
Design
Installation

Power Quality
Assessment
Installation

Not sure
On-site audits
In-depth engineering (full building)
Initial assessment (full building)
Lighting/electrical in-depth engineering
Lighting/electrical initial assessment
HVAC in-depth engineering
HVAC initial assessment

Facility Information

What type of facility do you have?

Residential strata
Small office (3 floors or less)
Large office (4 floors or more)

Primary school
Secondary school
Post secondary school

Extended Care
Hospital

Hotel/Motel
Manufacturing
Warehouse
Industrial
New Construction
Retail
Suburban mall
Strip mall
Stand alone mall
Grocery less than 12,000 sq. ft.
Grocery greater than 12,000 sq. ft.

Other: