Section 1 of 1 in this document

Experience Clean Heat Consumer Campaign

Download, fill out, and save the mandatory Consumer Site Participation Agreement. Then, upload it into the supporting documents section.

Please note: Partially completed information cannot be saved, be sure to have all details with you before beginning the form. Upon submission, you will receive a confirmation and a tracking number on your screen to print or save. Refer to this tracking number to check on the status of your request. For the best form completion experience, use the Google Chrome browser.

For full program details and eligibility, visit https://cleanheat.ny.gov/experience-clean-heat/. If you have any questions, reach out to ech @nyserda.ny.gov or call (917) 716-7597.

* Required field

Contact Information

Phone Number

Phone Extension

Site Information

Site Name

Street Address

Street Address 2

City

State

Zip/Postal Code

Site Type (Example: Restaurant, Library, Etc.)

What type of heat pump(s) does the site have?

Specify Other

Does the site have a heating/cooling system other than the heat pump(s)?

Yes

If yes, please explain.

Do the staff or patrons have any issues with space comfort? e.g. too hot, too cold, too humid?

Does the site promote sustainability?

Yes

If yes, how?

Marketing Considerations

Does the site host events?

Yes

If yes, approximately how many events per month/year?

Are there community events that take place in your area?

Yes

If yes, what are they?

Please estimate the number of patrons during off-peak hours.

Please estimate the number of patrons during peak hours.

Where do you see the biggest benefit for promotions?

Social Media

A component of Experience Clean Heat is a site's social media presence, especially an existing social media following and engagement from their followers. This includes frequent and dynamic posts and interaction with followers. Please complete the questions below. The field ambassador will review the site’s online presence.

Social Media

Facebook

Instagram

N/A

Website

X (formerly Twitter)

Provide the website address and if applicable, how often is this updated?

Provide the Facebook handle and if applicable, how often is there a new post?

Provide the Instagram handle and if applicable, how often is there a new post?

Provide the X handle and if applicable, how often is there a new post?

Please select which types of initiatives you would be willing to work with us on.

Events

Gift card giveaways

Other

Social media promotions and/or raffles

Other

Upload

Please ensure your document file name does not include any special characters, such as ~! @#$%^&*_-+=`|\(){}[]:;"'<>,.?/.

Consumer Site Participation Agreement

Authorized Signatory

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign this application. I am authorized and have legal signatory rights to enter into a contractual agreement on behalf of my company. I have read and agree to the terms contained in the application and Participation Agreement.

Recaptcha Response

Be sure to verify that you are not a robot by using the Captcha tool at the below.

Tracking Number

You will be provided with a Tracking Number upon submission.

Experience Clean Heat Consumer Campaign

Contact Information

Full Name

Site Information

Does the site have a heating/cooling system other than the heat pump(s)?

Does the site promote sustainability?

Marketing Considerations

Does the site host events?

Are there community events that take place in your area?

Social Media

Social Media

Please select which types of initiatives you would be willing to work with us on.

Upload

Consumer Site Participation Agreement

Authorized Signatory

Sign Here

Tracking Number