• Energy Savings Assistance Program

    If you qualify, Save money and energy with professional energy-savings home improvements a no cost to you.

  • Household Members

    You must enter information for ALL your household members living in the same address, including all adults and children.
  • Are you receiving income? *cash, social security, ssi, child support and pension are all considered as income**

  • House & Utility Information

  • Do you Live in?*
  • Is the address listed on this application owned or rented by the applicant?*
  • Estate Planning- Do you currently have a trust or will in place
  • Do you currently have solar panels installed?

  • Release of Customer Information

  • As a Utility Assistance Program/Weatherization Assistance Program participant, I do hereby give permission to obtain and release personal information regarding my case to other agencies as deemed necessary to further assist my household in accessing services and to funding sources for reporting purposes. Information requested / released may include, but is not limited to, the following: 1) Services provided to or requested from the household by Utility Assistance Program/Weatherization Assistance Program agency; 2) Status on utility accounts, payment and consumption histories; 3) Proof of income, residency, and household members;4) Employment;5) Education and 6) Proof of identity and citizenship for all household members.

    • The information provided is true and correct to the bestof my knowledge and belief.
    •  My household income has been calculated to determine the household yearly income, according to pre-established agency procedures.
    • I understand I may request a hearing to appeal a denial of eligibility,amount of assistance received, or a delay of service delivery.

      By signing this form, I authorize GFI, Just Life Financial Services, The Tax Finance Center, and the Utility Assistance Program/Weatherization Assistance Program, along with their authorized representatives, to:

      Contact Me Using the Following Methods:

      Email
      Text messages
      Phone calls (including automated or prerecorded calls)
      Purpose of Communication:

      To provide updates, information, and offers related to services and programs, including but not limited to energy efficiency programs, solar installations, life insurance, tax finance services, and weatherization assistance.
      To schedule appointments, follow up on inquiries, and share promotional materials.
      For customer service and account-related inquiries.
      Consent to Share Information:

      I understand that my contact information may be shared with third-party service providers or affiliates of GFI, Just Life Financial Services, The Tax Finance Center, and the Utility Assistance Program/Weatherization Assistance Program strictly for the purposes mentioned above.
      Acknowledgment of Opt-Out Rights:

      I acknowledge that I may revoke this authorization at any time by notifying any of the entities mentioned above in writing or by using the opt-out instructions provided in email, text, or phone communications.

     

    My signature indicates I have read the Release of Customer Information, Application Required Document List, received a copy of the Customer Acknowledgement and agree to abide by the terms stated.

  • Date Signed*
     / /

  • Declaration of Income Statement

    Please enter information for ALL your household members age 18 or above living in the same address.
  • Applicant Income Resource*

  • I certify that the above information is true and correct to the best of my knowledge and belief. I understand that the information will be verified to an extent; and, that I am subject to prosecution for providing false or fraudulent information.

  • Date Signed*
     / /

  • A representative will reach out to you shortly. To expedite the process, please have the following documents ready for submission.

    Instructions:
    Upload clear and legible photos of the following documents for all household members, including all adults and children residing at the same address.

    Identification Documents:

    Government-issued photo ID for all adults (e.g., driver’s license, state ID, or passport).
    Birth certificates for all children under 18 years of age.
    Proof of Residency:

    Utility bill, lease agreement, or other official documentation showing your current address.
    Proof of Income:

    Recent pay stubs or income statements for all working adults.
    Documentation for any additional sources of income (e.g., Social Security, unemployment, child support).
    Utility Information:

    Most recent utility bills (electricity, gas, water).
    Account numbers for utility providers if applicable.
    Additional Supporting Documents (if applicable):

    Proof of benefits or assistance programs (e.g., SNAP, WIC, Medicaid).
    Tax returns or bank statements for further financial verification.

    Important Notes:

    Ensure all photos are clear and free from glare.
    Double-check that documents are complete and legible to avoid delays.
    If you need assistance with gathering or uploading your documents, let us know during your representative’s follow-up.

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