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2. First Name*
3. Last Name*
5. Email Address*
6. Phone Number*
8. Address1*

   Please provide the address where the reimbursement for improvement is being requested.

10. Address2
12. City*
13. State*
14. Zip*
16. Parcel ID or Folio Number*
18. Property Type*
    -- Select One --ResidentialCommercial
19. Is the property a short term vacation rental?*
    -- Select One --YesNo
20. Is the property deemed historic?*
    -- Select One --YesNoUnsure
22. Proof of Residency/Ownership*

    For Residential: Proof of Residency (Driver's License, Utility Bill, etc.)

    For Commercial: Proof of Ownership (SunBiz Info, Business Tax Receipt, etc.)

    For Tenants: Copy of Lease Agreement and Affidavit of Approval from Property Owner

24. Requested Project Type*
    -- Select One --Solar Photovoltaic (PV) SystemENERGY STAR® HVACENERGY STAR® Cool RoofENERGY STAR® heat pump or solar water heater
25. Total Project Cost*
27. Quote #1*
28. Quote #2*
29. Quote #3*
31. Contractor License
32. Permits
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field