Low Income Rental Efficiency Program

Low Income Rental Efficiency Program

Tenant Application
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
Phone Type

Home Cell Work
Are you a CenterPoint Energy Customer? *

Yes No
CenterPoint Account Number *
Are you an Xcel Energy Electric Customer? *

Yes No
Xcel Energy Account Number *
Do you Own or Rent? *

Own Rent
What type of housing do you live in? *

Single Family Duplex Triplex Fourplex Apartment Mobile Home Townhouse
Are you a Section 8 Voucher Holder? *

Yes No
Landlord's Name *
Landlord's Phone Number:
How many people live in your household? *
What is your household's gross annual income? *
Did you receive a grant from the Energy Assistance Program since October 2018? *

Yes No Unknown
If you did not received Energy Assistance within the previous two years, you must provide proof of income. (Copy of federal tax return, copies of pay stubs for one month, proof of public assistance or Social Security payments, etc.) You can download your information here, fax to 651-774-0445, or mail to Energy CENTS Coalition, 823 E 7th St, St Paul, MN 55106.

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By signing this document, I agree to allow the Energy CENTS Coalition to obtain my account information from CenterPoint Energy and to share that information with other organizations and vendors that provide energy conservation and other relevant services. I verify that, to the best of my knowledge, all information on the application is correct.
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