Irrigation & Commercial Business Assessments SIGN UP FOR LOW OR NO COST* BUSINESS ENERGY ASSESSMENTS: + BUILDING ENVELOPE AND VENTILATION + HVAC AND WATER HEATING + LIGHTING + PLUG LOADS AND EQUIPMENT + ENERGY USE PATTERNS Irrigation Assessments Business Name Business Address Address Address 2 City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Business Contact Name Business Contact Number Business Contact Email Name of Electric Service Provider - None -SLV RECTri-State Meter Number(s) NAICS Code Approximate Number of Employees Select all that apply Agricultural Small Business Rural Other Do you intend to apply for Rural Energy for American Progam (REAP) funding? Yes No I am not familiar with this funding program Notes / Other / Please include which meters/pivots you'd like assessed. Signature Reset Sign above Authorization Text I am applying to participate in the Electrify and Save On-Bill Program (the "Program"). As part of the Program, Colorado Clean Energy Fund ("CCEF") needs to access 12 months of my historic utility bill information. I understand that information about my utility bill will be shared with CCEF, both initially to evaluate my application and on an on-going basis for as long as I am a participant in the Program. I hereby authorize the utility indicated on my utility bill to release the following information to CCEF and any of its representatives, agents, and contractors for the Program: Information to identify my account, including account numbers and identifiers for my service address. Bill history information, including prior disconnection notices, months of active service, the start date and any future move-out date. Information about my utility bill will be handled confidentially by CCEF, its representatives, agents and contractors for the Program. I understand that my authorization will remain effective from the date of my signature until my application evaluation is complete, and for as long as I am a participant in the Program and an on-bill obligation is outstanding at the service address identified above. I also understand that information and data collected may be used to assess the Program’s effectiveness and results, which will be anonymized and aggregated, and may be included in Program reports provided to Tri-State Generation. I have read and understand the nature of this authorization. CAPTCHA Math question 10 + 5 = Solve this simple math problem and enter the result. E.g. for 1+3, enter 4. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Status message *Assessment is free if you apply for federal funding through EQIP or REAP. If you do not apply with these programs, the assessment is $300. If no motor or VSD is recommended, the assessment will be covered. Status message This is an Equal Opportunity Program. Discrimination is prohibited by Federal Law. Submit
