ORGANIZATIONAL INFORMATION
Organization Name:
Mailing Address:
City:
State:
Zip:
County:
Facility Name:
(if different from Organization)
Facility Location Address:
(if different from Organization)
City:
State:
Zip:
County:
Contact First Name:
Contact Last Name:
Title:
Phone Number:
E-mail:
PLEASE ANSWER THE FOLLOWING QUESTIONS:
Indicate your organizational status:
Private, non-profit – 501(c)3
Government
Private, for profit
Other
Please select
If Other, please explain:
Your organization:
Owns the facility
Short-term/rents the facility
Please select
Has a long-term lease for the facility
Who are your utility vendors?
Electric Provider:
Natural Gas Provider:
Who is responsible for paying utilities?
Organization
Please select
Both
Residents
Briefly explain the population that your organization serves:
How long does your organization intend to remain at the location?
Has your organization conducted an energy audit on your facility in the last 5 years?
Yes
No
Please select
