{"id":10923,"date":"2020-08-12T09:28:05","date_gmt":"2020-08-12T15:28:05","guid":{"rendered":"https:\/\/siea.com\/?page_id=10923"},"modified":"2021-10-21T09:57:40","modified_gmt":"2021-10-21T15:57:40","slug":"empower-request","status":"publish","type":"page","link":"https:\/\/siea.com\/empower-request\/","title":{"rendered":"Empower Products &#038; Services Information Request"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;3.22&#8243;][et_pb_row _builder_version=&#8221;3.25&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;3.25&#8243; custom_padding=&#8221;|||&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_text _builder_version=&#8221;3.27.4&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221;]<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_unknown gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_12' >\n                        <div class='gform_heading'>\n                            <h3 class=\"gform_title\">Empower<\/h3>\n                            <p class='gform_description'>Empower is San Isabel Electric's energy-saving products and services program that can help anyone make power more affordable. Please complete this form or call 800-279-7432 (SIEA) and an Empower Program energy expert will contact you within ten business days.<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_12'  action='\/wp-json\/wp\/v2\/pages\/10923' data-formid='12' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_12' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_12_14\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_12_14\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_12_14'>Opportunity<\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_12_14' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_12_15\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_12_15\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_12_15'>Close Date<\/label><div class='ginput_container ginput_container_text'><input name='input_15' id='input_12_15' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_12_16\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_16\" ><label class='gfield_label gform-field-label' >Are you a member or non-member?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_12_16'>\n\t\t\t<li class='gchoice gchoice_12_16_0'>\n\t\t\t\t<input name='input_16' type='radio' value='Member'  id='choice_12_16_0'    \/>\n\t\t\t\t<label for='choice_12_16_0' id='label_12_16_0' class='gform-field-label gform-field-label--type-inline'>Member<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_16_1'>\n\t\t\t\t<input name='input_16' type='radio' value='Non-member'  id='choice_12_16_1'    \/>\n\t\t\t\t<label for='choice_12_16_1' id='label_12_16_1' class='gform-field-label gform-field-label--type-inline'>Non-member<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_12_21\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_21\" ><label class='gfield_label gform-field-label' >Are you interested in our 0% financing for 12 months offer (for members only)?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_12_21'>\n\t\t\t<li class='gchoice gchoice_12_21_0'>\n\t\t\t\t<input name='input_21' type='radio' value='Yes'  id='choice_12_21_0'    \/>\n\t\t\t\t<label for='choice_12_21_0' id='label_12_21_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_21_1'>\n\t\t\t\t<input name='input_21' type='radio' value='No'  id='choice_12_21_1'    \/>\n\t\t\t\t<label for='choice_12_21_1' id='label_12_21_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_12_17\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_17\" ><label class='gfield_label gform-field-label' >Is this a residential or commercial inquiry?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_12_17'>\n\t\t\t<li class='gchoice gchoice_12_17_0'>\n\t\t\t\t<input name='input_17' type='radio' value='Residential'  id='choice_12_17_0'    \/>\n\t\t\t\t<label for='choice_12_17_0' id='label_12_17_0' class='gform-field-label gform-field-label--type-inline'>Residential<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_17_1'>\n\t\t\t\t<input name='input_17' type='radio' value='Commercial'  id='choice_12_17_1'    \/>\n\t\t\t\t<label for='choice_12_17_1' id='label_12_17_1' class='gform-field-label gform-field-label--type-inline'>Commercial<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_12_1\" class=\"gfield gfield--type-name field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_1\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Name<\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_12_1'>\n                            \n                            <span id='input_12_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_12_1_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_12_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_12_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_12_1_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_12_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_12_19\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_19\" ><label class='gfield_label gform-field-label' for='input_12_19'>Business name (if applicable)<\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_12_19' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_12_3\" class=\"gfield gfield--type-email field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_3\" ><label class='gfield_label gform-field-label' for='input_12_3'>Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_3' id='input_12_3' type='email' value='' class='medium'     aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_12_4\" class=\"gfield gfield--type-phone field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_4\" ><label class='gfield_label gform-field-label' for='input_12_4'>Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_4' id='input_12_4' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_12_2\" class=\"gfield gfield--type-address field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_2\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Address<\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_12_2' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_12_2_1_container' >\n                                        <input type='text' name='input_2.1' id='input_12_2_1' value=''    aria-required='false'    \/>\n                                        <label for='input_12_2_1' id='input_12_2_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_12_2_2_container' >\n                                        <input type='text' name='input_2.2' id='input_12_2_2' value=''     aria-required='false'   \/>\n                                        <label for='input_12_2_2' id='input_12_2_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_12_2_3_container' >\n                                    <input type='text' name='input_2.3' id='input_12_2_3' value=''    aria-required='false'    \/>\n                                    <label for='input_12_2_3' id='input_12_2_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_12_2_4_container' >\n                                        <input type='text' name='input_2.4' id='input_12_2_4' value=''      aria-required='false'    \/>\n                                        <label for='input_12_2_4' id='input_12_2_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_12_2_5_container' >\n                                    <input type='text' name='input_2.5' id='input_12_2_5' value=''    aria-required='false'    \/>\n                                    <label for='input_12_2_5' id='input_12_2_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_12_2_6_container' >\n                                        <select name='input_2.6' id='input_12_2_6'   aria-required='false'    ><option value='' selected='selected'><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_12_2_6' id='input_12_2_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_12_11\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_11\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Products and Services<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_12_11'><li class='gchoice gchoice_select_all'>\n\t\t\t\t\t\t<input class='gfield-choice-input' type='checkbox' id='choice_11_select_all'   onclick='gformToggleCheckboxes( this )' onkeypress='gformToggleCheckboxes( this )' \/>\n\t\t\t\t\t\t<label for='choice_11_select_all' id='label_11_select_all' class='gform-field-label  gform-field-label--type-inline' data-label-select='Select All' data-label-deselect='Deselect All'>Select All<\/label>\n\t\t\t\t\t<\/li><li class='gchoice gchoice_12_11_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.1' type='checkbox'  value='Water Heaters'  id='choice_12_11_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_11_1' id='label_12_11_1' class='gform-field-label gform-field-label--type-inline'>Water Heaters<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_11_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.2' type='checkbox'  value='QuietCool'  id='choice_12_11_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_11_2' id='label_12_11_2' class='gform-field-label gform-field-label--type-inline'>QuietCool<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_11_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.3' type='checkbox'  value='ETS Heaters'  id='choice_12_11_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_11_3' id='label_12_11_3' class='gform-field-label gform-field-label--type-inline'>ETS Heaters<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_11_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.4' type='checkbox'  value='Solar'  id='choice_12_11_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_11_4' id='label_12_11_4' class='gform-field-label gform-field-label--type-inline'>Solar<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_11_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.5' type='checkbox'  value='HVLS Fans'  id='choice_12_11_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_11_5' id='label_12_11_5' class='gform-field-label gform-field-label--type-inline'>HVLS Fans<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_11_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.6' type='checkbox'  value='Electric Forced Air Heaters'  id='choice_12_11_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_11_6' id='label_12_11_6' class='gform-field-label gform-field-label--type-inline'>Electric Forced Air Heaters<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_11_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.7' type='checkbox'  value='Fans'  id='choice_12_11_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_11_7' id='label_12_11_7' class='gform-field-label gform-field-label--type-inline'>Fans<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_11_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.8' type='checkbox'  value='Other'  id='choice_12_11_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_11_8' id='label_12_11_8' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_11_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.9' type='checkbox'  value='Insulation'  id='choice_12_11_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_11_9' id='label_12_11_9' class='gform-field-label gform-field-label--type-inline'>Insulation<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_11_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.11' type='checkbox'  value='EV Chargers'  id='choice_12_11_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_11_11' id='label_12_11_11' class='gform-field-label gform-field-label--type-inline'>EV Chargers<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_11_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.12' type='checkbox'  value='Generator Plug'  id='choice_12_11_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_11_12' id='label_12_11_12' class='gform-field-label gform-field-label--type-inline'>Generator Plug<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_11_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.13' type='checkbox'  value='Generators'  id='choice_12_11_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_11_13' id='label_12_11_13' class='gform-field-label gform-field-label--type-inline'>Generators<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_11_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.14' type='checkbox'  value='Air Conditioning'  id='choice_12_11_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_11_14' id='label_12_11_14' class='gform-field-label gform-field-label--type-inline'>Air Conditioning<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_11_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.15' type='checkbox'  value='Battery Storage'  id='choice_12_11_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_11_15' id='label_12_11_15' class='gform-field-label gform-field-label--type-inline'>Battery Storage<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_11_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.16' type='checkbox'  value='All Electric Home'  id='choice_12_11_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_11_16' id='label_12_11_16' class='gform-field-label gform-field-label--type-inline'>All Electric Home<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_11_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.17' type='checkbox'  value='Energy Assessment'  id='choice_12_11_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_11_17' id='label_12_11_17' class='gform-field-label gform-field-label--type-inline'>Energy Assessment<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_12_12\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_12\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >How did you hear about Empower?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_12_12'><li class='gchoice gchoice_12_12_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_12.1' type='checkbox'  value='Billboard'  id='choice_12_12_1'   aria-describedby=\"gfield_description_12_12\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_12_12_1' id='label_12_12_1' class='gform-field-label gform-field-label--type-inline'>Billboard<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_12_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_12.2' type='checkbox'  value='Colorado Country Life magazine'  id='choice_12_12_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_12_2' id='label_12_12_2' class='gform-field-label gform-field-label--type-inline'>Colorado Country Life magazine<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_12_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_12.3' type='checkbox'  value='Online ad (Google or other site)'  id='choice_12_12_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_12_3' id='label_12_12_3' class='gform-field-label gform-field-label--type-inline'>Online ad (Google or other site)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_12_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_12.4' type='checkbox'  value='News story (newspaper, online, TV or radio)'  id='choice_12_12_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_12_4' id='label_12_12_4' class='gform-field-label gform-field-label--type-inline'>News story (newspaper, online, TV or radio)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_12_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_12.5' type='checkbox'  value='Saw an ad during an online program (Hulu, Sling TV, YouTubeTV, etc.)'  id='choice_12_12_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_12_5' 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Please complete this form or call 800-279-7432 (SIEA) and an Empower Program energy expert will contact you within ten business days.<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_12'  action='\/wp-json\/wp\/v2\/pages\/10923' data-formid='12' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_12' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_12_14\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_12_14\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_12_14'>Opportunity<\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_12_14' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_12_15\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_12_15\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_12_15'>Close Date<\/label><div class='ginput_container ginput_container_text'><input name='input_15' id='input_12_15' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_12_16\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_16\" ><label class='gfield_label gform-field-label' >Are you a member or non-member?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_12_16'>\n\t\t\t<li class='gchoice gchoice_12_16_0'>\n\t\t\t\t<input name='input_16' type='radio' value='Member'  id='choice_12_16_0'    \/>\n\t\t\t\t<label for='choice_12_16_0' id='label_12_16_0' class='gform-field-label gform-field-label--type-inline'>Member<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_16_1'>\n\t\t\t\t<input name='input_16' type='radio' value='Non-member'  id='choice_12_16_1'    \/>\n\t\t\t\t<label for='choice_12_16_1' id='label_12_16_1' class='gform-field-label gform-field-label--type-inline'>Non-member<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_12_21\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_21\" ><label class='gfield_label gform-field-label' >Are you interested in our 0% financing for 12 months offer (for members only)?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_12_21'>\n\t\t\t<li class='gchoice gchoice_12_21_0'>\n\t\t\t\t<input name='input_21' type='radio' value='Yes'  id='choice_12_21_0'    \/>\n\t\t\t\t<label for='choice_12_21_0' id='label_12_21_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_21_1'>\n\t\t\t\t<input name='input_21' type='radio' value='No'  id='choice_12_21_1'    \/>\n\t\t\t\t<label for='choice_12_21_1' id='label_12_21_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_12_17\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_17\" ><label class='gfield_label gform-field-label' >Is this a residential or commercial inquiry?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_12_17'>\n\t\t\t<li class='gchoice gchoice_12_17_0'>\n\t\t\t\t<input name='input_17' type='radio' value='Residential'  id='choice_12_17_0'    \/>\n\t\t\t\t<label for='choice_12_17_0' id='label_12_17_0' class='gform-field-label gform-field-label--type-inline'>Residential<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_17_1'>\n\t\t\t\t<input name='input_17' type='radio' value='Commercial'  id='choice_12_17_1'    \/>\n\t\t\t\t<label for='choice_12_17_1' id='label_12_17_1' class='gform-field-label gform-field-label--type-inline'>Commercial<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_12_1\" class=\"gfield gfield--type-name field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_1\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Name<\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_12_1'>\n                            \n                            <span id='input_12_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_12_1_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_12_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_12_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_12_1_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_12_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_12_19\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_19\" ><label class='gfield_label gform-field-label' for='input_12_19'>Business name (if applicable)<\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_12_19' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_12_3\" class=\"gfield gfield--type-email field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_3\" ><label class='gfield_label gform-field-label' for='input_12_3'>Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_3' id='input_12_3' type='email' value='' class='medium'     aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_12_4\" class=\"gfield gfield--type-phone field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_4\" ><label class='gfield_label gform-field-label' for='input_12_4'>Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_4' id='input_12_4' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_12_2\" class=\"gfield gfield--type-address field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_2\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Address<\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_12_2' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_12_2_1_container' >\n                                        <input type='text' name='input_2.1' id='input_12_2_1' value=''    aria-required='false'    \/>\n                                        <label for='input_12_2_1' id='input_12_2_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_12_2_2_container' >\n                                        <input type='text' name='input_2.2' id='input_12_2_2' value=''     aria-required='false'   \/>\n                                        <label for='input_12_2_2' id='input_12_2_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_12_2_3_container' >\n                                    <input type='text' name='input_2.3' id='input_12_2_3' value=''    aria-required='false'    \/>\n                                    <label for='input_12_2_3' id='input_12_2_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_12_2_4_container' >\n                                        <input type='text' name='input_2.4' id='input_12_2_4' value=''      aria-required='false'    \/>\n                                        <label for='input_12_2_4' id='input_12_2_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_12_2_5_container' >\n                                    <input type='text' name='input_2.5' id='input_12_2_5' value=''    aria-required='false'    \/>\n                                    <label for='input_12_2_5' id='input_12_2_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_12_2_6_container' >\n                                        <select name='input_2.6' id='input_12_2_6'   aria-required='false'    ><option value='' selected='selected'><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_12_2_6' id='input_12_2_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_12_11\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_11\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Products and Services<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_12_11'><li class='gchoice gchoice_select_all'>\n\t\t\t\t\t\t<input class='gfield-choice-input' type='checkbox' id='choice_11_select_all'   onclick='gformToggleCheckboxes( this )' onkeypress='gformToggleCheckboxes( this )' \/>\n\t\t\t\t\t\t<label for='choice_11_select_all' id='label_11_select_all' class='gform-field-label  gform-field-label--type-inline' data-label-select='Select All' data-label-deselect='Deselect All'>Select All<\/label>\n\t\t\t\t\t<\/li><li class='gchoice gchoice_12_11_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.1' type='checkbox'  value='Water Heaters'  id='choice_12_11_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_11_1' id='label_12_11_1' class='gform-field-label gform-field-label--type-inline'>Water Heaters<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_11_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.2' type='checkbox'  value='QuietCool'  id='choice_12_11_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_11_2' id='label_12_11_2' class='gform-field-label gform-field-label--type-inline'>QuietCool<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_11_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.3' type='checkbox'  value='ETS Heaters'  id='choice_12_11_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_11_3' id='label_12_11_3' class='gform-field-label gform-field-label--type-inline'>ETS Heaters<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_11_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.4' type='checkbox'  value='Solar'  id='choice_12_11_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_11_4' id='label_12_11_4' class='gform-field-label gform-field-label--type-inline'>Solar<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_11_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.5' type='checkbox'  value='HVLS Fans'  id='choice_12_11_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_11_5' id='label_12_11_5' class='gform-field-label gform-field-label--type-inline'>HVLS Fans<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_11_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.6' type='checkbox'  value='Electric Forced Air Heaters'  id='choice_12_11_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_11_6' id='label_12_11_6' class='gform-field-label gform-field-label--type-inline'>Electric Forced Air Heaters<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_11_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.7' type='checkbox'  value='Fans'  id='choice_12_11_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_11_7' id='label_12_11_7' class='gform-field-label gform-field-label--type-inline'>Fans<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_11_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.8' type='checkbox'  value='Other'  id='choice_12_11_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_11_8' id='label_12_11_8' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_11_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.9' type='checkbox'  value='Insulation'  id='choice_12_11_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_11_9' id='label_12_11_9' class='gform-field-label gform-field-label--type-inline'>Insulation<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_11_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.11' type='checkbox'  value='EV Chargers'  id='choice_12_11_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_11_11' id='label_12_11_11' class='gform-field-label gform-field-label--type-inline'>EV Chargers<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_11_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.12' type='checkbox'  value='Generator Plug'  id='choice_12_11_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_11_12' id='label_12_11_12' class='gform-field-label gform-field-label--type-inline'>Generator Plug<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_11_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.13' type='checkbox'  value='Generators'  id='choice_12_11_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_11_13' id='label_12_11_13' class='gform-field-label gform-field-label--type-inline'>Generators<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_11_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.14' type='checkbox'  value='Air Conditioning'  id='choice_12_11_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_11_14' id='label_12_11_14' class='gform-field-label gform-field-label--type-inline'>Air Conditioning<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_11_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.15' type='checkbox'  value='Battery Storage'  id='choice_12_11_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_11_15' id='label_12_11_15' class='gform-field-label gform-field-label--type-inline'>Battery Storage<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_11_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.16' type='checkbox'  value='All Electric Home'  id='choice_12_11_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_11_16' id='label_12_11_16' class='gform-field-label gform-field-label--type-inline'>All Electric Home<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_11_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.17' type='checkbox'  value='Energy Assessment'  id='choice_12_11_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_11_17' id='label_12_11_17' class='gform-field-label gform-field-label--type-inline'>Energy Assessment<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_12_12\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_12\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >How did you hear about Empower?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_12_12'><li class='gchoice gchoice_12_12_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_12.1' type='checkbox'  value='Billboard'  id='choice_12_12_1'   aria-describedby=\"gfield_description_12_12\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_12_12_1' id='label_12_12_1' class='gform-field-label gform-field-label--type-inline'>Billboard<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_12_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_12.2' type='checkbox'  value='Colorado Country Life magazine'  id='choice_12_12_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_12_2' id='label_12_12_2' class='gform-field-label gform-field-label--type-inline'>Colorado Country Life magazine<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_12_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_12.3' type='checkbox'  value='Online ad (Google or other site)'  id='choice_12_12_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_12_3' id='label_12_12_3' class='gform-field-label gform-field-label--type-inline'>Online ad (Google or other site)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_12_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_12.4' type='checkbox'  value='News story (newspaper, online, TV or radio)'  id='choice_12_12_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_12_4' id='label_12_12_4' class='gform-field-label gform-field-label--type-inline'>News story (newspaper, online, TV or radio)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_12_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_12.5' type='checkbox'  value='Saw an ad during an online program (Hulu, Sling TV, YouTubeTV, etc.)'  id='choice_12_12_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_12_5' 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