Field Data Upload Form - Earth Sensitive Solutions, LLC

Layout

Name *

First

Last

Name of person submitting this form

Email *

Email of person submitting

Enter Amp Rating of Electrical Service

Typically 100 or 200, will be indicated by large top breaker in Circuit Breaker Box

Project Name *

Example: Jones

Project Address *

Example: 2299 Electric Dr.

NYSEG Account Number *

Example: 1001-1001-101

Upload Wide Angle Picture of Mechanical Equipment *

Click or drag files to this area to upload. You can upload up to 3 files.

Please upload a picture of furnace/boiler standing back to get a full wide angle shot

Number of Gas Appliances

# Selected: 1

Indicate the number of Gas Appliances (you will need to upload pictures of nameplate data indicating input rating)

Name of First Gas Appliance *

First Appliance should be Furnace, Boiler or Hot Water Heater

Picture of Nameplate of First Appliance *

Click or drag files to this area to upload. You can upload up to 3 files.

Please upload a clear, focused high resolution of Appliance Nameplate indicating Input Rating. (file types .png, .jpg, .gif, .svg, .psd, .tiff, .jpeg only)

Name of Second Gas Appliance *

Picture of Nameplate of Second Appliance *

Click or drag files to this area to upload. You can upload up to 3 files.