Customer Enquiry Form
First Name
Last Name
Email
Home size in square mt
Stratrum
1
2
3
4
5
6
How much do you pay for Electricity in $COP
Home address (to calculate radiation)
Number of people living in the home
Electronics you use
Fridge
Dishwasher
Oven
Hob
Washing machine
Electric Car
Number of lights /lamps
Number of computers run daily
Number of printers run daily
Number of mobile phones
Number of IPads
Number of Televisions
Number of Stereos
Any others? Please describe…
Do you leave all appliances connected to the plug all the time?
Yes
No
Sometimes
Please add a legible photo of your full electricity bill including contract number
Submit
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