Qualified Appliance Replacement - Short Application - April 2022 5
Property Manager/Owner Acknowledgment Form
Property Manager/Owner Information
Check if customer owns property
Property Management Company/Owner Name (if any) _____________________________________________________________
Contact Name __________________________________________ Contact Title ____________________________________________
Main Phone ______________________________ Ext. ___________ Secondary Phone ________________________________________
Contact Email ___________________________________________
Mailing Address __________________________________________ City _________________________ State ______ ZIP ____________
Tenant Name ____________________________________________
Property Address _________________________________________ City _________________________ State ______ ZIP ____________
My signature certifies that I am aware that the tenant at the address listed above has my permission to replace
appliances in the home that they are leasing.
Property Manager/Owner Name (print) _____________________________________________________________________________
Title ____________________________________________________ Signature ________________________________________________
Date ___________________________________________________
• I understand that PowerShift by NV Energy (“NVE”) is
conducting Qualified Application Replacement (“Offer”). This
Offer is at no cost to me. The Installer may install a free dryer
and refrigerator. I may also receive LED light bulbs, advanced
power strip and dusk to dawn lighting control, but in no event
will the Installer repair any appliances or fixtures. I authorize
the Installer to enter my property and perform services to be
rendered under the Offer and I understand that there is no
guarantee that the installation of these devices will achieve
energy savings.
• I understand that in order to receive the new appliance(s) the
Installer must remove and dispose of the old appliance(s). I
am aware that in no circumstance will the old appliance(s) be
left on the premises.
• I am fully aware that the Installer is not an employee of NV
Energy and is a third party contractor who has entered into
a contract with NV Energy to provide certain services for the
benefit of their customers. I elect to voluntarily participate in
the Offer and assume all risk of loss, damage, or injury that
sustained by property or by me in the performance of services
by the Installer.
• To the maximum extent allowed by law, I acknowledge
and agree that NV Energy (including their employees and
contractors) shall not be liable for any loss, damage or injury
that may be sustained by me or my property arising from or in
connection with any act or omission of the Installer or the
Installer’s agents or subcontractors in performing the Offer. I
hereby waive any and all claims against NVE that may arise in
connection with the Offer.
• I agree to maintain the energy saving appliance and
products in my home for 5 years.
• By signing below, I certify that I have read, understand, and
agree to the above terms and conditions.
By typing my name above I certify that this is my digital signature.
Please complete all fields.
