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American Water Heater UP300 Specifications Page 6

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PRIMARY BUSINESS TYPE
(select one)
TAX STATUS
(as entered on W9)
(describe other)
Natural
g
as provide
r
Electricit
y
provide
r
Pro
j
ect T
y
pe
NAME OF APPLICANT'S BUSINESS (MUST MATCH REPORTING TAXPAYER ID #)
PROJECT NAME (IF APPLICABLE)
CONSUMERS ENERGY ELECTRIC ACCOUNT # (where measure is installed) DBA (IF APPLICABLE)
1000 -
2011 INCENTIVE APPLICATION
CUSTOMER INFORMATION
Important: Please read the terms and conditions before signing and submitting this application. You must complete all information and provide
required documentation to avoid processing delays.
Assembly
Small Retail
College/University
Schools (K-12)
Full Service Restaurant
Grocery
Hospital
Hotel
Large Office
Light Industry
Heavy Industry
Miscellaneous
Corporation (Inc., PC, Etc...)
T
ax Exemp
t
Individual
Other (may receive 1099)
Consumers Energy
DTE Energy
Other
Consumers Energy
DTE Energy
Other
Existing Building
New Construction
Major Renovation
Fast Food Restaurant
Big Box Retail
Warehouse
Small Office
CONSUMERS ENERGY GAS ACCOUNT # (where measure is installed) TAXPAYER ID # (SSN/FEIN)
1000 -
NAME AS IT APPEARS ON CONSUMERS ENERGY BILL
NAME OF CONTACT PERSON TITLE OF CONTACT PERSON
CONTACT PHONE # EXTENSION CONTACT FAX # CONTACT E-MAIL ADDRESS
INSTALLATION ADDRESS CITY STATE ZIP
MAILING ADDRESS CITY STATE ZIP
NAME OF CONTRACTING COMPANY
NAME OF CONTACT PERSON TITLE OF CONTACT PERSON
CONTACT PHONE # EXTENSION CONTACT FAX # CONTACT E-MAIL ADDRESS
MAILING ADDRESS CITY STATE ZIP
Page 6 Rev. Mar 30, 2011
CONTRACTOR INFORMATION
Assembly
Small Retail
College/University
Schools (K-12)
Full Service Restaurant
Grocery
Hospital
Hotel
Large Office
Light Industry
Heavy Industry
Miscellaneous
Corporation (Inc., PC, Etc...)
T
ax Exemp
t
Individual
Other (may receive 1099)
Consumers Energy
DTE Energy
Other
Consumers Energy
DTE Energy
Other
Existing Building
New Construction
Major Renovation
Fast Food Restaurant
Big Box Retail
Warehouse
Small Office
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