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Green Jobs Green New York Residential Loan Fund Advance Payment Program Participation Agreement

Signature Form

The authorized company contact must electronically sign this participation agreement. Any other signors will not be accepted.

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Company Information

Company Physical Address

Is the physical address the same as the mailing address?

Company Mailing Address

DBA Certificate (Only required if your Legal Business Name and Business Name/Disregarded Entity Name are different)

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By electronically signing this form, I attest that I have legal signatory rights to enter into a contractual agreement on behalf of my company.

I have read, understand, and agree to comply with all participation commitments in NYSERDA's Green Jobs Green New York Residential Loan Fund Advance Payment Program Participation Agreement, including all participation statuses and all supporting policies described or referenced therein. I understand that my participation in the Program is not approved until NYSERDA has reviewed and approved this Agreement. I understand the provisions of this Agreement are effective from the date of approval by NYSERDA. NYSERDA reserves the right to modify, at any time during this Agreement term, the provision of this Agreement. I certify under the penalties of law that the statements made in the Agreement and in supporting documentation provided along with this Agreement, have been examined by me and are true and complete. I understand that by signing this Agreement, I consent to any other inquiry to verify or confirm the information I have given.

Authorized Signature

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Tracking Number

You will be provided with a Tracking Number upon submission.