Form
BUILDING ENERGY SAVERS Partnered with My Opus
Michigan Energy Rebates
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate Phone / Family Member
Please enter a valid phone number.
Format: (000) 000-0000.
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is this your primary residence?
Yes
No
Electric Service Provider:
Electric Service Account Number (Optional):
Do you heat your home with natural gas:
Yes
No
Natural Gas Provider (Optional):
Natural Gas Provider Account Number:
Heating Fuel Provider (Optional):
Heating Fuel Provider Account Number (Optional):
How did you hear about us?
I am a:
Homeowner
Renter
Please provide your property manager's contact information below:
Property Manager's Name
Company Name (Optional):
Property Manager's Email:
example@example.com
Property Manager's Phone:
Please enter a valid phone number.
Format: (000) 000-0000.
Do any members of your household participate in an assistance program?
Yes
No
Which public assistance program is your household currently enrolled in?
Food Assistance Program
Medicaid
State Emergency Relief
Last 4 digits of your Social Security Number:
Have you already received an approval to participate in the MI Home Energy Rebates (MiHER) Program?
Yes
No
If you have an approval, what type is it?
Standard
Enhanced
Documents to provide:
Income for all members of household (Pay Stubs, Tax Returns, or W-2 Forms). If receiving public assistance (Medicaid Award Letter). Proof of residence ownership (property tax bill, home insurance statement, or mortgage statement). If you have an approval please submit it. Email documents to: MyOpusDocs@buildingenergysavers.com. If you have any questions you can reach Carlos Oxholm and his team at 313-451-0070.
Submit
Should be Empty: