Electrify & Save Weatherization Interest Form

Record Type Name

Welcome!

First things first, are you in need of an emergency replacement for your primary heat source?

YesNo

If you are a LEAP recipient, please contact Energy Outreach Colorado for emergency heat replacement.

Thank you for your interest in energy efficiency and electrification discounts provided by your rural electric cooperative.

Please make sure your utility is listed among the electric utilities offering these discounts and that you qualify.

Electric Utility Provider

Below is a table to help you check if you qualify based on your household size.* If you make less than the amount listed, you qualify! Keep in mind that income thresholds are higher in some areas, so if you live in a higher-income area or a resort community, you may still qualify.

*Household members are people who live with you for whom you have financial responsibilities, not roommates.

When you get to the end and hit “submit,” this interest form is sent to your local, non-profit weatherization service provider. The weatherization service provider will contact you to provide more details and the program application. They will verify your income and may request income documentation.

If you have questions, please contact your electric utility.

Enter your Account Number

The Account Number can be found on your utility bill.

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First Name

Last Name

Email

Phone

Street Address with Unit

City

State Abbreviation

Zip Code

Is mailing address different than service address?

Street

City

State Abbreviation

Zip Code

How did you hear about our program?

Where did you hear about the program other details

Do you currently participate in any income-based programs (LEAP, LIHEAP, WAP, SNAP, TANF, etc.)?