1 Eligibility2 Applicant Information3 Co-Applicant Information4 Property Information5 Authorization EligibilityWhat type of loan are you seeking?*WeatherizationHeat PumpSolarDuctless Heat PumpRequested loan amount (from bid estimate):*Please upload your current contractor bid for the proposed project.*Bid must be from contractor participating in the utility’s Contractor Network. Drop files here or Accepted file types: jpg, gif, png, pdf, docx. Loan Applicant InformationWould you like to add a co-applicant to this application?*YesNoName* First Last Date of Birth* Date Format: MM slash DD slash YYYY Social Security Number*Why do you need my SSN? Social Security Numbers (SSN) are required to run credit reports on each applicant. This website is encrypted and secure. If you do not have a social security number or do not want to provide your SSN on this electronic application, call Energy Services at 3355 for a paper application which you can fill out and submit in person at one of our office locations.Mailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email Address* Phone Number*Alternate Phone NumberDuration at current address*Years*Months*Have you lived at your current address for less than 2 years?*YesNoPrevious Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Previous Electric Utility*Employer*Employment Length*Years*Months*Length of Employment*Gross monthly income:*Please include proof of income:*For example: The last two current pay stubs or last year's tax return. Drop files here or Accepted file types: jpg, gif, png, pdf, docx. Co-Applicant InformationName* First Last Date of Birth* Date Format: MM slash DD slash YYYY Social Security Number*Why do you need my SSN? ocial Security Numbers (SSN) are required to run credit reports on each applicant. This website is encrypted and secure. If you do not have a social security number or do not want to provide your SSN on this electronic application, call Energy Services at 3355 for a paper application which you can fill out and submit in person at one of our office locations.Mailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email Address Phone NumberAlternate Phone NumberDuration at current address*Years*Months*Less than two years at current address?*YesNoPrevious Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Previous Electric Utility*Employer*Length of Employment*Years*Months*Length of Employment*Gross monthly income of Co-Applicant:*Please include proof of income for the co-applicant:*For example: The last two current pay stubs or last year's tax return. Drop files here or Accepted file types: jpg, gif, png, pdf, docx. Property InformationAddress of property/residence where proposed work will be performed:* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Name of home mortgage company or institution (bank or lending company):*Monthly Mortgage Payment Amount*Mortgage Balance*Did you have a second mortgage holder?*YesNoName of second home mortgage company or institution (bank or lending company):*Second Monthly Mortgage Payment Amount*Second Mortgage Balance*Number of persons living in home, if owner occupied* Certification & Authorization Certify Loan Application Information I certify the above to be true and correct to the best of my knowledge. I understand this application, whether or not it is approved, will be retained for at least 3 years. I understand I may be asked to provide additional documentation to support my home equity if it is not publicly available. I understand this application and my credit report are valid for 45 days and any credit reports needed by Clark Public Utilities after that time may incur an additional fee. I understand that I am only eligible to finance a weatherization, heat pump and/or ductless heat pump loan if the home I own where the work will be completed is an electrically heated home. I understand that I am solely liable for any improvements to my property/residence that are made in conjunction with this conservation loan. I further agree, before the work begins, I will finalize the remaining documentation for this loan and provide any additional information requested by Clark Public Utilities. Credit Report Authorization I hereby authorize the Clark Public Utilities to verify my past and present employment earnings records, bank accounts, and any other asset balances that are needed to process my loan application. I further authorize Clark Public Utilities to order a consumer credit report and verify other credit information, including past and present mortgage and landlord references. It is understood that a copy of this form will also serve as authorization. The information Clark Public Utilities obtains is only to be used in the processing of my application for a loan. Privacy Act Notice This information is to be used by the agency collecting it or its assignees in determining whether you qualify as a prospective borrower under its program. It will not be disclosed outside the agency except as required and permitted by law. You do not have to provide this information, but if you do not your application for approval as a prospective borrower may be delayed or rejected.Applicant Certification:* I certify that the information provided is correct. Authorization:* I authorize Clark Public Utilities to run a credit report Applicant Signature*Co-applicant Certification:* I certify that the information provided is correct. Authorization:* I authorize Clark Public Utilities to run a credit report Co-applicant Signature* This iframe contains the logic required to handle Ajax powered Gravity Forms.
