Customer Approval Form

Efficiency Vermont offers a choice of two incentives to help Vermont homeowners pay for comprehensive energy efficiency improvements completed by a certified Home Performance with ENERGY STAR contractor:

Interest Rate Reduction Incentive - Efficiency Vermont partners with several lenders across the state to offer a 3.5% interest rate reduction on loans of $15,000 or less for terms of 5 years or less. A list of participating lenders can be found at www.efficiencyvermont.com/homeperformance (click on the financing link).

10% Cash Incentive (Limited time offer) - For energy efficiency improvements pre-approved and installed between October 1, 2008 and March 31, 2009, Efficiency Vermont will pay 10% of the installation costs up to $500. This incentive is paid to the contractor upon receipt of required project completion documents. This cash incentive offer may be combined with any financing option except Efficiency Vermont's Interest Rate Reduction Incentive.

In order to qualify for either of these Efficiency Vermont incentives, Efficiency Vermont must pre-approve your proposal for energy efficiency improvements. This review helps to assure that the proposal will deliver cost-effective energy savings while ensuring that potential health and safety issues are addressed.

Note: These incentive offers are not available to customers who receive incentives from Vermont Gas Systems.

Please complete the following information. This form must be completed and submitted to Efficiency Vermont prior to installation of energy efficiency improvements in order to qualify for incentives.

You must also submit the proposal (cost estimate & scope of work for energy efficiency improvements) that your contractor provided.

Name (first & last):^*
Phone:^*
Email:^*
Fax:

Mailing Address:^*

Address:^*
Address 2:
City:^*
State:^*
Zip:^*

Installation Address: (if different)

Address:
Address 2:
City:
State:
Zip:

Are these energy efficiency improvements for your primary Vermont residence?^*

Home Performance with ENERGY STAR contractor who will be installing the energy efficiency improvements:^*
Home Performance with ENERGY STAR contractor who performed your energy audit (if different):

Please specify which incentive option you plan to pursue

	I plan to pay cash and get Efficiency Vermont’s 10% Cash Incentive for my home energy efficiency improvements.
	I plan to use Efficiency Vermont’s 3.5% Interest Rate Reduction Incentive offered through participating lenders to finance my home energy efficiency improvements (may not be combined with 10% Cash Incentive).
	I plan to get a Warm & Weatherized Loan with TD Banknorth and get Efficiency Vermont’s 10% cash incentive for my home energy efficiency improvements.
	I plan to pursue other financing and get Efficiency Vermont’s 10% cash incentive for my home energy efficiency improvements.

Name of Lender/Financial Institution:

I authorize my fuel dealer to provide information about my pre- and post-retrofit fuel usage to Efficiency Vermont for evaluation purposes.

Name of Fuel Dealer:

^*Required.
We do not share any personally identifiable information (name, address, telephone number, email) with any third party. We do not sell, trade, or give away any information that is obtained by us.

In order to qualify for incentives, you must also submit the proposal (cost estimate & scope of work for energy efficiency improvements) that your contractor provided.

Please send your contractor’s proposal to Efficiency Vermont by fax, email or mail.

Email:
HomePerformance@veic.org
Please scan and attach the contractor’s proposal.

Mail:
Efficiency Vermont
Attn: Home Performance with ENERGY STAR Customer Approval
255 S. Champlain St., Suite 7
Burlington, VT 05401

Fax:
802-658-1643

Efficiency Vermont will review your Customer Approval form and respond within five business days.