Section A – Individual Application InformationFull Name (as listed on GVEA membership)(Required) First Last SSN/EIN(Required)Birthdate(Required) MM slash DD slash YYYY Phone(Required)Email(Required) Enter Email Confirm Email Installation Address(Required) Street Address Address Line 2 City 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 State ZIP Code Years at current address(Required)Do you currently own or rent the dwelling to be improved? Own Rent Dwelling Type(Required) Single Family Multi Family Other - please describe Do you currently occupy the dwelling to be improved:(Required) Yes No Number of Household Members(Required)Current address is different than installation address(Required) Current address is different than installation address Current Address(Required) Street Address Address Line 2 City 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 State ZIP Code Mailing address is different than current address(Required) Mailing address is different than current address Mailing Address(Required) Street Address Address Line 2 City 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 State ZIP Code Employer Name/Source of Income(Required)Section B – Joint Applicant InformationJoint Applicant(Required) A co-borrower/spouse owns or occupies the home at the above installation address Joint Applicant Name(Required) First Middle Last SSN/EIN(Required)Birthdate(Required) MM slash DD slash YYYY Years at current address(Required)Do you currently own or rent the dwelling to be improved?(Required) Own Rent Do you currently occupy the dwelling to be improved:(Required) Yes No Employer Name/Source of Income(Required)Gross Income(Required)Annual Income(Required)Section C – Utility InformationMeter Number(Required)GVEA Account Number(Required)Section D – Property DetailsSquare Footage(Required)Number of Stories/Levels(Required)Heat Source(Required)Year Built(Required)Section E – Funding informationFunding Amount requested(Required)Minimum funding amount is $500. Maximum funding amount is $10,000.Please enter a number from 500 to 10000.Section F – Type(s) of Upgrade/InstallationWhat installations/upgrades will the funding be used for? Check all that apply(Required) Energy efficient appliance(s) Weatherization Lighting improvements Solar Please briefly describe the projects checked above for which you are requesting funding.(Required)0 of 500 max charactersSection G – Maintenance AgreementAs part of the program, GVEA must offer Maintenance Agreement. A Maintenance Agreement can be added for an additional cost to maintain the original functionally of certain equipment. It is important to note, in the event that a member sells their service location with an ongoing REDUCE loan and no Maintenance Agreement, the member must pay the full balance at that time, unless a separate waiver is obtained by the home buyer. For details on what is covered under the Maintenance Agreement, any exclusions that apply, and the monthly cost, review the agreement HERE.Would you like to request a Maintenance Agreement? No Yes File UploadsMember must obtain and upload a quote from a contractor/retailer for the total cost of equipment/installation for application to be considered complete.Contractor / Retailer Quote(Required) Drop files here or Select files Max. file size: 300 MB. Section I – Member Acknowledgments and SignatureCorporate/legal disclosures and jargon hereApplicant Signature(Required)Joint Applicant Signature(Required)
