Window and Insulation Incentive Form

Name & Last Name(Required)

Email(Required)

Phone(Required)

Address(Required)

Select Basement Type(Required)

Select Primary Heating System(Required)

Select Secondary Heating System

Is it a rental property?(Required)

Yes

Please sign below:

Your electronic signature agrees to these terms and conditions and authorizes H.E.L.P. Group INC to submit an application and all required invoices or measure documentation to Energy Trust on Customer's behalf. By that authorization, Customer represents to Energy Trust that all measures have been completed satisfactorily as of the signature date below, and that any accompanying invoices or measure documentation are complete and accurate. If your incentive application meets energy Trust requirements, the cash incentive will be paid to you within 4-6 weeks of receipt of the application.

Agree

If you would rather complete this agreement manually and send it back to us, please check below this box

At what location is the service required?(Required)

Astoria, OR

Portland, OR

Name

This field is for validation purposes and should be left unchanged.

Window and Insulation Incentive Form

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