EnergySmart – Round 3 – 2012 » app1

Application

Part 1 of 5: Customer and Contractor Informaton

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Business Customer Information
Company*
Parcel number*
If you need help finding your Parcel number see the Assessor's website
Site address*
City*
State*
Zip*
Does the business customer own or lease the property?*
Owns
Leases
If the property is leased please provide the following information for the owner.
Owner's name**
Address**
City**
 State**
 Zip**
Tel**
Business Type (please select one)*
 Restaurant
 Grocery Store
 Liquor Store
 Lodging/Accommodation
 Auto Body/Repair
 Retail (including auto sales)
 Office Building
 Medical Office (including dental and veterinary)
 Manufacturing
 Dry Cleaner/Laundromat
 Religious Worship
 Multi-Family Units
 Educational Buildings
 Other
Affected Square Footage*
(Applies to lighting, HVAC and Building Envelope measures)
Contact Person
Name*
Title*
Email*
Tel*
Fax
Mailing address (if different)
City
 State
 Zip
Contractor information
Company name*
Address*
City*
 State*
 Zip*
Tel*
Fax
Email*
Select all that apply:*
 Association of Energy Engineers (AEE)
 Building Performance Institute (BPI)
 Commercial Energy Services Network (COMNET)
 DOE/ITP Specialist
 Residential Energy Services Network (RESNET)
 North American Technical Excellence (NATE)
 American Society of Heating, Refrigerating, and Air Conditioning Engineers (ASHRAE)
 Other:
Total number of contractors' labor and administrative hours worked on project.*
Facility/project site characteristics
Electric Utility Provider*
Electric Customer Account Number*
Gas Utility Provider*
Gas Customer Account Number*
Does the facility use propane?
 Yes
Facility has (please check one):*
 Heated space only Air conditioned space

*Required Field

**Required Field If Business Leases the Property