"*" indicates required fields InstagramThis field is for validation purposes and should be left unchanged.Member Name* First Last Site Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Mailing Address* Same as site address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone*Email* Project Type*New Home On PropertyReplacing Existing Manufactured Home On PropertyHome Square Footage*Please enter a number from 1 to 10000.Heating System Type*Electric FurnaceHeat PumpDuctless Heat PumpElectric Resistance (baseboard, wall heat)Water Heating System Type*Electric Heat Pump Water HeaterElectric Resistance Tank Water HeaterElectric TanklessOtherFile Upload*Please upload a copy of your NEEM certificate that was provided by the manufacturer or sales company you purchased your home through. Drop files here or Select files Accepted file types: jpg, gif, pdf, png, Max. file size: 100 MB. Would You Like Your Rebate Applied as a Bill Credit?* Yes No Electronic Member SignatureTerms & Conditions* FUNDING AVAILABILITY: BPA incentives are available for products purchased, work performed, and homes certified on a first-come, first served basis. BPA funding may be subject to change. ELIGIBILITY: BPA/CEC incentives are available to Northwest Energy Efficiency Manufactured Homes Program certified homes served by CEC. PAYMENT: The incentive will be promptly paid on (i) submission of the completed Incentive Application with all required information attached, (ii) verification of compliance of BPA Northwest Energy Efficient Manufactured Home Measure Requirements. Please allow 45 days for receipt of payment after verification and inspection. ACCESS AND EVALUATION: BPA/CEC and/or its representatives may request access to the property and may review and evaluate the project during and after completion. Builder hereby agrees to provide reasonable access to the property for the purposes described herein. DISCLAIMER / NO LIABILITY: CEC member understands that, while BPA/CEC is providing member with funding for the incentive payment, BPA/CEC is not supervising the work performed for member nor is BPA/CEC responsible in any way for proper completion of that work or proper performance of any equipment purchased. BPA/CEC is simply providing funding to assist member in implementing energy saving measures. BPA/CEC does not guarantee any particular energy savings results by its approval of the Application or by any other of its actions. INDEMNIFICATION: CEC member assumes the entire responsibility for, and agrees to indemnify, protect, defend, and hold harmless BPA/CEC and its representatives, officers, agents, employees, contractors and members from any and all claims, damages, losses, expenses or liability, including liabilities to third parties, liability for injuries or damages allegedly sustained by any person or property as a result of, or in any way connected with or arisen out of this agreement. SURVIVAL OF TERMS AND CONDITIONS: Regardless of whether or not this application is approved, these terms and conditions shall survive the payment of any incentives payment provided hereunder. By checking this box and typing my name, I certify that all information on this form is true and correct and I am following the terms and conditions outlined above. I also agree that the checkbox and my name typed below are to be used as my electronic signature. I understand that I can be held liable if I provide false or misleading information.*By checking this box and typing my name, I certify that all information on this form is true and correct and I am following the terms and conditions outlined above. I also agree that the checkbox and my name typed below are to be used as my electronic signature. I understand that I can be held liable if I provide false or misleading information. I certify the above information is true and correct and I am the person submitting this form. Type Full Name*Consent* I agree to the CEC Privacy Policy.
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