| Please complete the following: | Qty | kWh | Cost/Month | Cost/Day | 
                            
                                | Is water tank wrapped? |  |  |  |  | 
                            
                                | # of people in household? |  |  |  |  | 
                            
                                | # of tubs/baths per week/per household? |  |  |  |  | 
                            
                                | # of showers per week/ per household? |  |  |  |  | 
                            
                                | # of hot water laundry loads per week? |  |  |  |  | 
                            
                                | # of warm water laundry loads per week? |  |  |  |  | 
                            
                                | # of hand dish washings per week? |  |  |  |  | 
                            
                                | # of automatic dish washing loads per week? |  |  |  |  |