ELECTRIFY EVERYTHING APPLICATION STEP 1: Applicant Information Name First Middle Last Account Number 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 Phone Email Is this a rental property installation? If yes, owner approval is required. Please call us at (970) 887-3378, EXT 6. Yes No STEP 2: Energy Investment Type(s) Please tell us which programs you are applying for. Check all that apply. Cold-Climate Air-Source Heat Pump Commercial EV Charging Station Insulation Upgrade Solar Installation STEP 3: Home Fuel Type What type of fuel is used in this home. Check all that apply. Electric Gasoline/Diesel Heating Oil Propane Wood Other… Enter other… This step applies only to insulation and cold-climate, air-source heat pump applicants. STEP 4: Current HVAC Type What is your PRIMARY source of heating in the home or space to be conditioned? Baseboard Ducted Heat Pump Ductless Heat Pump Electric Furnace Fireplace Oil Pellet Stove Propane Space Heaters Wood Other… Enter other… STEP 5: Type of Home Please indicate the type of home. Detached single-family Manufactured home Duplex Condo/Townhouse Apartment/Multi-family Other… Enter other… How many stories in your home? How many square feet is your home? STEP 6: Program Awareness How did you hear about MPE's Electrify Everything program? Ad - online Ad - print Bill / bill insert Colorado Country Life magazine Contractor referral e-Newsletter Event MPE web site Social media Other… Enter other… STEP 7: Contractor Estimate Contractor Estimate One file only.100 MB limit.Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods. Status message Upon submission of this application, MPE will determine the applicant's eligibility to participate in this program. You must submit a complete application, including project estimate from a qualified, licensed installer. NOTE: If approved, MPE agrees only to pay the contractor's estimate. Any cost overruns are the sole responsibility of the applicant (MPE member). Your signature: Sign above