Fillable RESIDENTIAL LOAN WORK SCOPE FORM (Efficiency Maine)

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RESIDENTIAL LOAN WORK SCOPE FORM (Efficiency Maine)

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EFFICIENCY MAINE
RESIDENTIAL LOAN WORK SCOPE FORM
Submit by email: lending@neifund.org, or mail to NEIF, 1005 Brookside Road, Suite 200, Allentown, PA 18106
Rev. 1.20.2021
Please submit this form and itemized quotes to process loan. Project eligibility confirmation
required prior to start of upgrade. Efficiency Maine may contact your installer to confirm work scope eligibility.
REQUIREMENTS
☐
Except for prerequisites, project is eligible for an Efficiency Maine residential rebate (lifetime limits do not apply)
☐
Itemized quote for eligible work scope submitted with this form
☐
Borrower is a homeowner, not a business
☐
Prerequisites for upgrades (e.g., health & safety measures) do not exceed 25% of the loan.
Homeowner Name:
Site Address, Town, State, Zip:
Mailing Address, Town, State, Zip:
Email Address:
Phone Number:
Number of dwellings in building:
☐ 1 ☐ 2 ☐ 3 ☐ 4
Is the home more than 50 years old?
☐ Y ☐ N
Will upgrade be visible from street?
☐ Y ☐ N
#
Upgrade Description
Registered Vendor
☐
1
☐
2
☐
3
☐
4
#
Description of Prerequisites
Registered Vendor
☐
5
Total Project Cost:
Total Loan Request Amount:
SIGNATURE. Please certify that all information on this form is correct by signing below.
Homeowner Signature:
Date:
For Internal Use Only
Proposed building, upgrade, and installer are eligible for an Efficiency Maine residential rebate.
Eligibility Confirmed by:
Date:
Ref#:
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RESIDENTIAL LOAN WORK SCOPE FORM (Efficiency Maine)

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Completed 23 July 2021

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