VERSION 06.01.2020 – PREVIOUS VERSION WILL NOT BE ACCEPTED Page 5 of 7
I acknowledge that NYSERDA has retained Energy Finance Solutions (“EFS”), a service offered by Slipstream Inc., to process this application
and underwrite my/our loan. I authorize EFS to obtain credit reports in connection with my/our loan request. I also authorize EFS to verify
records necessary to assure eligibility for my/our loan request. If necessary, I further agree to provide additional information to EFS to
underwrite my/our loan request.
I acknowledge that the energy efficiency improvements being made to the home, or installation of a renewable energy system, are designed
to reduce my energy costs or provide health and safety improvements, and my contractor will provide estimates of future energy cost savings
based on energy modeling, or the contribution of a renewable energy system, which may vary from the results I will realize. The estimate may
include assumed increases in future energy costs, which may not reflect actual future energy costs. These savings are not guaranteed by
either the contractor or NYSERDA. Incurring this loan to undertake these improvements may not result in the estimated reduction in energy
costs over time, based on additional factors that contribute to monthly energy usage and costs.
I acknowledge the interest rate for my loan will be determined based upon the income screening of the installation property household(s),
unless I have opted out of the income screening in Section A of this application. Opting out of the screening will result in my/our loan
application defaulting to the highest interest rate available through the NYSERDA Program for my installation type at the time my/our loan
application is decisioned.
I further acknowledge and agree that NYSERDA and EFS may share with and disclose to, orally and/or in writing, the project partner(s)
identified by me above, or as subsequently identified by me to EFS, the following information regarding this application: whether the
application has been pre-approved by EFS, and any additional items requested by EFS in order to complete my loan approval; whether the
application has been approved by EFS, and the approved loan amount so that my project partner(s) can proceed with scheduling the work;
and whether my application has been denied, so that the project partner(s) can determine if there is other financing available, and whether I
intend to proceed.
In addition, if this application is approved and NYSERDA makes the On-Bill Recovery Loan I have requested, I also authorize NYSERDA, its
loan servicer, and the utility providing my gas and/or electric service and their employees, contractors, and agents to share such information
concerning: my electric and/or gas utility usage and billing information; and the charges that are payable by me under the loan agreement
(note) that I will sign.
The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion,
national origin, sex, marital status, or age.
Whether or not the undersigned have elected to sign this document electronically, EFS, and or any subsequent holders of this document,
shall have the right to convert and store the manual signature electronically, and the undersigned consents to the use of the electronically
stored version in the same manner as an original signed copy.
I understand and intend that a legal signature is formed by entering my name on this and other documents provided to me, and by entering
my name on this and other documents provided in relation to this transaction I intend for my electronic signature to have the same force and
effect as my manual signature. If any of the parties do not wish to sign this document electronically, all must opt out together and request a
paper copy to sign manually.
By entering my name below, I am creating a legally binding signature and confirm that I agree and accept the electronic signature terms and
SECTION K – INCOME SCREENING FOR INTEREST RATE AND INCENTIVE
Special instructions for borrower(s) who occupy the installation property:
If you have already listed all of your household income in Section I, please identify in the table below if either borrower is a full-time student;
answer the question below the table regarding 1) number of people in the household; 2) HEAP, public assistance, or other services; and
complete Section L.
If you have opted out of the income screening in Section A of this application, do not receive HEAP or public assistance, and neither borrower
is a full-time student, you do not need to complete the remainder of this application.
If you have additional household members and/or income sources, please complete the remainder of the application.
If you do not occupy the installation property, please request the occupant(s) to complete the remainder of this, or a separate income