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This is not a contract for a loan (Energy Finance Solutions)

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Version 02.01.17
Consumer Credit Application
This is not a contract for a loan nor does it lock you into any commitment with a contractor. This is an application that will allow us to proceed with your
request for a loan to finance your improvement(s). This will include reviewing your credit history.
Properties held in trust may be eligible for financing if at least one occupant and all named trustees apply for the loan and meet program eligibility
requirements. Use additional applications if necessary, and fill out only Section A and/or Section B for additional applicants. A full trust review will be
performed if the property is held in a trust. The review is subject to a fee, currently set at $157.07 per trust. Properties that require more than one trust
review may be subject to additional fees. Paying the fee for the trust review does not guarantee that a loan can be made.
Please complete all fields. Incomplete applications will be returned to you for completion. Only residential work that has not been started is eligible for
financing. Upon completion of the application, please submit the credit application, along with a copy of a recent electric utility bill, driver’s license or other
valid government identification, lease (if applicable), to: Energy Finance Solutions, 431 Charmany Drive, Madison, WI 53719 or fax to 608.249.5788
SECTION A – INDIVIDUAL APPLICANT INFORMATION
Mr/Mrs/Ms
Last Name
First Name
MI
Jr/Sr/I/II
Birth Date
Social Security Number
Installation Address (where home improvements are to be made)
Unit #
City
State
Zip
Island associated with the installation address
Years at Current Address
Is the land on which the dwelling is to be improved:
Owned Leased
Dwelling Type (Multi [3+ units] does not qualify):
Single Family Duplex Other
Do you currently own or rent the dwelling to be improved:
Own Rent
Do you occupy the dwelling to be improved:
Yes No
No. of Household Members
Current Address (if different than the above installation address)
City
State
Zip
Mailing Address (if different than the above current address)
City
State
Zip
Employer Name/Income Source
Monthly Gross Income
$
Gross Annual Household Income
$
SECTION B – JOINT APPLICANT
Complete only for joint credit (if Joint Applicant is a Co-Borrower/Spouse, they must own and occupy the home at the above installation address).
Mr/Mrs/Ms
Last Name
First Name
MI
Jr/Sr/I/II
Birth Date
Phone
Social Security Number
Current Address (if different than the above installation address)
City
State
Zip
Do you currently own or rent the dwelling to be improved:
Own Rent
Do you currently occupy the dwelling to be improved:
Yes No
Years at Current Address
Employer Name/Income Source
Monthly Gross Income
$
Version 02.01.17
Consumer Credit Application
SECTION C – UTILITY INFORMATION
Electric Utility Co.
Electric Utility Account Holder Name
Electric Utility Account Number
Please provide your circuit penetration as a percentage of the utility’s (HECO, MECO or HELCO) Daytime Minimum Load. Utility Circuit penetration can be obtained from
your contractor or online at www.hawaiianelectric.com/lvm.
SECTION D – INSTALLER INFORMATION
Installer Name
Estimated Project Cost
By completing and submitting an application, I/we certify that I/we am/are of legal contracting age and that I/we have read, understand, and agree to all
of the terms stated here. By signing below, I/we certify that all information provided on this application is correct and complete to the best of my/our
knowledge. I/we acknowledge that GEMS has retained Energy Finance Solutions (EFS), a service offered by WECC, to process this application and
underwrite my/our loan. I/we authorize(s) EFS to obtain credit reports in connection with my/our loan request. If necessary, I/we further agree to
provide additional information to WECC/EFS to underwrite my/our loan request. I/we understand and authorize EFS and WECC to retain this
application whether or not it is approved.
I further agree, as the authorized energy supplier account holder, that GEMS and WECC/EFS may share with and disclose to, orally and/or in writing,
the contractor identified by me above, or as subsequently identified by me to EFS, the following information regarding this application: energy usage
history; whether the application has been preapproved by EFS and any additional items requested by EFS in order to complete my loan approval;
whether the application has been approved by EFS so that my contractor(s) can proceed with scheduling the work; and whether my application has
been denied so that the contractor(s) can determine if there is other financing available and whether I intend to proceed.
Additionally, if this application is approved and the loan I/we have requested is made, I/we also authorize WECC/EFS to share such information
concerning: my/our electric and/or gas utility billing account number; the charges payable by me/us under the promissory note that I/we will sign; and
other non-public information that I/we provided. I further authorize 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 with WECC/EFS, and GEMS and/or its agent(s).
I/We understand that the contractor completing my/our installation will be funded for the full amount of the project, less the origination fee, upon
satisfactory completion of the installation. No origination fees shall be paid directly by me/us to either WECC/EFS or the contractor, and the origination
fee shall be reflected in the Annual Percentage Rate (APR) for the financing made available to me/us.
I/We understand and agree that EFS and WECC do not guarantee the security of any data submitted electronically and will not be held responsible or
liable for interception by third parties. I/We understand and agree that in no event will EFS or WECC be liable for any technical, hardware or software
failure of any kind, any interruption in the availability of this service, any delay in operation or transmission, any incomplete transmission, computer
virus, loss of data, or other similar loss.
The State is required according to section 92F-12(a)(8) of the Hawaii Revised Statutes to collect and make available upon request “the name, address
and occupation of any person borrowing funds from a state or county loan program and the amount, purpose, and current status of the loan.”
My signature also authorizes and grants HGIA unrestricted permission to share the information provided on this application with HGIA’s Servicing
Agent, HGIA’s Board of Directors and the State of Hawaii.
The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applications on the basis of race, color, religion, national
origin, sex, marital status, or age.
Applicant’s Signature
Date
Joint Applicant’s Signature
Date
Applicant’s Email Address
Joint Applicant’s Email Address
www.energyfinancesolutions.com
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Completed 21 March 2021

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