Customer registration form

Complete the following survey to determine if you quality for Home Comfort Program reabates.

Survey

Customer registration Home Comfort Program form

Complete the following form to determine if you quality for Home Comfort Program rebates. If you receive HEAP or other income qualified benefits, please click one of the links below to learn more about income related energy efficiency services. Long Island Customers ( Nassau, Queens-Far Rockway, Suffolk ) Home Comfort Program Team. New York Customers ( Brooklyn, Queens, Staten Island )

    Part 1/4: Home Comfort Program apply form

    Zip code*

    Customer Type*

    Nationadl Grid NY ( KEDNY )

    Part 2/4: Customer Information

    Customer Information

    Customer First Name

    Customer Last Name

    Are you working with a Partner ?

    Do you own your home ?

    What style of home do you have ?

    Part 3/4: House information

    What concerns led you to our site today: ( check all that apply )

    Are the specific improvements you are looking to make to your home: ( check all that apply )

    What type(s) of insulation do you have in your walls, floor and ceiling/attic? ( select all that apply )

    How soon do you plan to complete your weatherization project?

    How did you hear about this program?

    Part 4/4: Customer additional information

    Street Address
    City
    State
    Zip Code
    Email
    Phone

    Home Comfort Program provides customers the option to have their contact information forwarded to a Home Comfort Program Approved Partner as a convenience to the Customer. The Customer acknowledges that the contractor is an independent home service vendor. While Home Comfort Program  Approved Partners work in collaboration, the Partners are not contractors or subcontractors of Home Comfort Program. Therefore, the Customer is responsible to undertake their own careful inquiry when engaging and contracting directly with the Partner contractors for services pertaining to their home.

    By filing or checking this box and providing my contact information, I give permission for Home Comfort Program to forward this information to a Home Comfort Program Approved Partner ( Partner ) and for ther Partner contract me directly to offer products and services related to Home Comfort Program weatherization Program.

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