Heart of the Earth - Transportation Energy Use Form

Transportation Energy Use Form

Please Print, complete and return this form to:

Heart of the Earth, 9601-16 Miccosukee Road, Tallahassee, FL 32308
Call (850) 216-8400 for more information

To track your savings and reduction on CO2 emissions from transportation related activities provide us with the following information. If you have a good record of your gasoline consumption easily at hand, as many folks do these days, you can use the leftmost two columns of this table to enter your data. If you only keep track of your monthly gasoline costs you can provide us with that information along with the grade of gasoline (octane) you purchase. Place that information in the rightmost two columns of this table and we will be able to reconstruct a fair estimate of your gasoline usage and impact on CO2 emissions.

Member Name/Address:
Month	Gasoline Consumption, Last Year (In Gallons)	Gasoline Consumption Current Year (In Gallons)	Gas Cost	Grade of Gasoline (Octane)
January
February
March
April
May
June
July
August
September
October
November
December

If you're not inclined to keep explicit records of your gasoline consumption you can use this form.

Member Name/Address:
Average number of miles driven per week	Miles
Number of miles per week you intend to save by carpooling or eliminating unnecessary trips	Miles
Gas mileage of your vehicle	MPG

How would you like to receive your annualized projections? E-mail ______ or Snail mail ______
E-mail address: ______________________________________________________