First Name *

Last Name *

Email *

Phone *

Preferred Contact Method: --None-- Phone Email Direct Email Text Other

If Other, please specify

Property Type: --None-- Residential (1-4 units) Nonprofit Small commercial Multifamily (5+ units)

Relationship to Property: --None-- Owner Tenant Property Manager Contractor

Number Of Building Units

Your address will help us determine if you prequalify for certain programs, grants or incentives.

Physical Address 1

Address 2
City
Zip
County: --None-- Albany Allegany Bronx Broome Cattaraugus Cayuga Chautauqua Chemung Chenango Clinton Columbia Cortland Delaware Dutchess Erie Essex Franklin Fulton Genesee Greene Hamilton Herkimer Jefferson Kings Lewis Livingston Madison Monroe Montgomery Nassau New York Niagara Oneida Onondaga Ontario Orange Orleans Oswego Otsego Putnam Queens Rensselaer Richmond Rockland Saratoga Schenectady Schoharie Schuyler Seneca St. Lawrence Steuben Suffolk Sullivan Tioga Tompkins Ulster Warren Washington Wayne Westchester Wyoming Yates --Outside of NYS

Same as Physical Address
Mailing Address
Mailing City
Mailing Zip

Same as Mailing Address
Utility Service Mailing Address
Utility Service Mailing City
Utility Service Mailing Zip

For Residential Units:
Household Income: --None-- Group A (market rate) Group B (moderate income) Group C (low income)

?

How did you hear about us?: --None-- Community or Workplace Presentation Community Event Friend or Family Social Media Newspaper Radio TV Other

If Other, please specify

Tell us what you interested in learning more about?:

Hold down the Ctrl (windows) or Command (Mac) button to select multiple options.

Is there anything else you would like to tell us?

I authorize release of my contact and dwelling information to representatives of NYSERDA and/or its designated representatives, to any community-based organizations, and to my utilities for the purposes of enrollment into other NYSERDA programs as well as programs offered by federal, state, and/or local entities that I may be eligible for.

I Agree