NYSERDA FORM 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 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. –None– Agricultural Energy Incentives Clean Energy Jobs and Training Electrification Energy Efficiency Heat Pumps Identifying Clean Energy Workforce Lower Utility Bills Partner with the Regional Clean Energy Hub Renewable Energy Solar Energy Volunteer Opportunities Wind Energy Other Is there anything else you would like to tell us? I authorize the 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 Sharing is caring!
