By signing below, I certify that all information provided on this application, including statements and documents submitted in connection with this application, are correct and complete to the best of my knowledge. I acknowledge that NYSERDA has retained a Contractor to process my income qualification application. If necessary, I further agree to provide additional information to complete my income screening application process.
I further acknowledge and agree that NYSERDA and its Contractor may share with and disclose to, orally and/or in writing the project partners identified by me above, or as subsequently identified by me to the Contractor, the following information regarding this application; whether the application has been approved by the Contractor, and any additional items requested by the Contractor in order to complete my income qualification application; whether the application has been approved by the Contractor; and whether my application has been denied, so that the project partner(s) can determine whether I intend to proceed.
I understand that my signature on this form gives permission for NYSERDA, or its designee, to verify records necessary to assure my program eligibility. I understand that if I give false information or withhold information in order to make myself eligible for benefits that I am not entitled to, I can be prosecuted to the fullest extent of the law.
I understand this application does not guarantee assistance will be granted but will be used in determining eligibility for the program. Whether or not an eligible applicant will be provided assistance will depend in part upon the number of applicants received, the remaining funding available, and the priorities to be met by the program.
Whether or not the undersigned have elected to sign this document electronically, the Contractor, and or any subsequent holders of this document, shall have the right to convert and store the manual signature electronically, and the undersigned consents to the use of electronically stored version in the same manner as an original signed copy.
I understand and intent that a legal signature is formed by entering my name on this and other documents provided to me, and by entering my name on this and other documents provided in relation to this transaction I intent for my electronic signature to have the same force and effect as my manual signature. If any of the parties do not wish to sign this document electronically all must opt out together and request a paper copy to sign manually.