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ENERGY SERVICE AGREEMENT FOR OCCUPANTEnergy Service Agreement • February 17th, 2016
Dwelling Information Select the Dwelling Type I am the Single-Family Mobile Home Multi-Unit Owner-Occupant Tenant Owner-Occupant or Tenant Information Owner-Occupant or Tenant (Print or type name) Address Apt./Unit No. City ZIP Code Telephone Number Owner-Occupant or Tenant Email Address Owner-Occupant or Tenant FAX Number Owner-Occupant or Tenant Acceptance of Terms for CSD Weatherization Services(to be completed by the Owner-Occupant or Tenant) I agree to accept the following TERMS required for my primary residence to receive services from the Department of Community Services and Development (CSD) weatherization programs(s): 1. I certify that the above-listed property is my primary residence. 2. I (the Owner-Occupant or Tenant), grant the Contractor/Agency permission to enter my dwelling to perform assessments, conduct diagnostics, take photos only of weatherization work to be performed or deferred (as it relates to individual or whole house services), install fea
