Energy Efficiency Loan Application – Individual

Applicant Information
Full Name*
First Middle Initial Last
Date*
Month
Day
Year
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Social Security Number*
Date of Birth*
Month
Day
Year
Driver License number
Drive License state*
Property Address*
Street Address Address Line 2 City State ZIP Code
Length of time at this address*
CWREMC Account Number*
Mortgage Holder*
Current Mortgage Payment*
Do you have a joint applicant or co-signer?*
- Yes
- No
Full Name - Joint Applicant / Co-Signer*
First Middle Initial Last
Date - Joint Applicant / Co-Signer*
Month
Day
Year
Address - Joint Applicant / Co-Signer*
Street Address Address Line 2 City State ZIP Code
Phone - Joint Applicant / Co-Signer*
Email - Joint Applicant / Co-Signer*
Social Security Number - Joint Applicant / Co-Signer*
Date of Birth - Joint Applicant / Co-Signer*
Month
Day
Year
Employment
Employment Status*
- Fulltime Employee
- Part-time Employee
- Not Employed
Yearly Income*
Employment Address*
Street Address Address Line 2 City State ZIP Code
How long at job?*
Work Phone Number*
Other Income
Additional information if Joint application or Co-Signer
Employment Status - Joint Applicant / Co-Signer*
- Fulltime Employee
- Part-time Employee
- Not Employed
Employment Address - Joint Applicant / Co-Signer*
Street Address Address Line 2 City State ZIP Code
Yearly Income - Joint Applicant / Co-Signer*
How long at job? - Joint Applicant / Co-Signer*
Work Phone Number - Joint Applicant / Co-Signer*
Other Income - Joint Applicant / Co-Signer
Energy Efficient Loan
Check the items for which financing is requested.*
- Geo-thermal system
- Air to Air Heat Pump
- Insulation
- Air Sealing
- Crawlspace encapsulation
- Window Upgrades
- Door Upgrades
- Heat Pump Water Heater
- High Efficiency Motor
- Var Frequency Drives
- Energy Audit
- Other (Specify)
Other*
Description of work to be done*
Work to be done by (See attached list)*
Amount of Estimate*
Attach copy of Estimate*
Accepted file types: jpg, jpeg, gif, png, pdf, docx, doc, tiff, Max. file size: 120 MB.
Loan amount requested*
Loan term*
- 12 months
- 24 months
- 36 months
- 48 months
- 60 months
- 72 months
- 84 months
- 96 months

(800) 844-7161

Applicant Information

Employment

Additional information if Joint application or Co-Signer

Energy Efficient Loan

(800) 844-7161