Instructions:
Partially completed information cannot be saved, so please be sure to have all details available before beginning the form.
Select Resident for utility accounts that serve only one apartment. If you are filling out the Resident form and have any questions, please contact the person who requested that you fill out this form.
Select Owner for utility accounts that serve common areas, or central heating, or central ventilation; or master accounts for an entire building. If you are filling out the Owner form and have any questions, please contact your Solutions Provider or NYSERDA Project Manager.
For Owner accounts: if you have more than one account of a specific energy type, please fill out and sign the form below, entering only one account number for each type of energy. Then download this Excel Form, fill it out to include all the accounts at your project, and upload it on the Multiple Account Excel section.
* Required field
Select the Category
Submit this form ONLY for direct-metered resident utility accounts.
Resident Name
Contact Name
Name on the Electric Account
If you have multiple Electric Utility accounts, enter just one account number here, then use the Multiple Accounts Form below to submit all the additional account numbers.
Do you have a gas utility account number?
Name on the Gas Account
If you have multiple gas accounts, enter just one account number here, then upload the Multiple Accounts Form below to submit all the additional account numbers.
Select All Types of Energy Used at this Project
Name on the Oil Account
Name on the Steam Account
Name on the Propane Account
Name on the Account
Do you have more than one account number for any energy type listed on this form?
Download the Multiple Account Excel Form, fill it out to include all the accounts at your project, and upload it in the section below.
Multiple Account Excel
My signature certifies that I am an authorized representative of the property owner and customer listed on this application. I hereby consent and authorize the release of any and all information, including account number(s), and data related to energy and/ or natural resource consumption at the above listed property address to representatives of the New York State Energy Research and Development Authority (NYSERDA) and/or its designated representatives for the period beginning two years prior to the application date and ending ten years after program participation. I understand that this information will be kept confidential, to the extent permitted by law, and used only for the purpose of determining program eligibility, estimating energy savings, program implementation, and evaluation, including the evaluation of achieved energy savings.
By completing this form and submitting, you authorize NYSERDA to access and utilize your past, current, and 120-month future energy/resource billing and consumption information/data so that it can effectively track the performance of your building’s energy utilization systems.
My signature certifies that I am an authorized representative of the property owner and customer listed on this application. I hereby consent and authorize the release of any and all information, including account number(s), and data related to energy and/or natural resource consumption at the above listed property address to representatives of the New York State Energy Research and Development Authority (NYSERDA) and/or its designated representatives for the period beginning two years prior to the application date and ending ten years after program participation. I understand that this information will be kept confidential, to the extent permitted by law, and used only for the purpose of determining program eligibility, estimating energy savings, program implementation, and evaluation, including the evaluation of achieved energy savings.
Sign Here
Tracking Number