EcoHome Loan Application

EcoHome Payment Plan Application

Application Date - Hidden - Do Not delete Regex note for Customer name

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Customer Information

Customer name (first and last) No punctuation necessary

Customer PG&E account number 10 Digits Numeric

Email

Phone

Social Security Number

Property address

Address Line 2

City

State

ZIP Code

Assessor's Parcel Number (APN) APN should follow this format XXX-XX-XXX

Name of property owner(s) of record

Number of years/months at property

Employer Information

Employer name

Address of employer

Address Line 2

City

State

ZIP Code

Employer phone number

Number of years at employer Round to the nearest whole number

Please upload proof of identity verification:

Below is the list of acceptable documents. The document provided must show your full name as listed in the application. We ask for this to validate that the PG&E account holder is the person submitting this application.
1. State identification (ID) card
2. Driver license
3. US passport or passport card
4. US military card
5. Military dependent’s ID card
6. Permanent Resident Card
7. Certificate of Citizenship
8. Certificate of Naturalization
9. Employment Authorization Document
10. Foreign passport

Upload identity verification document

If you are renting, please provide the required executed Property Owner Attestation of Approval.

Please upload proof of home or condo insurance.

Project Information

The following questions will help us determine your estimated total payment plan amount and monthly payments. Refer to your contractor bid to answer these questions.

Please upload your contractor bid

Name of Selected Contractor Value is not selected

Enter Name of Contractor

Eligible upgrades to take place (select all that apply) Please note a project is only eligible for financing if a heat pump HVAC or heat pump water heater upgrade is one of the upgrades to take place. Insulation must be paired with a HP-HVAC system installation in order to qualify for the payment plan. Values are not selected

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If applying for heat pump spacing heating and cooling (HP-HVAC), please attach one photo of the existing furnace for each gas furnace you are looking to replace. Photo(s) are required for payment plan approval.

If applying for heat pump water heating (HPWH), please attach one photo the existing water heater for each gas heater you are looking to replace. Photo(s) are required for payment plan approval.

If applying for an Electrical Service Panel Upgrade, please attach one photo of your existing electrical panel that clearly shows its below 200amps. Photo(s) are required for payment plan approval.

If applying for an Attic Insulation, please attach one photo of your existing insulation showing current depth. Photo(s) are required for payment plan approval.

Per your contractor bid, what is the total cost of your eligible upgrades before any rebates?

How much in San José Clean Energy rebates do you expect to receive? If you are unsure, refer to the Rebate Amounts section of the EcoHome Rebate webpage (https://sanjosecleanenergy.org/ecohome-rebate/#amounts) or ask your contractor. Rebates reduce the cost of your project and are therefore factored into the payment plan amount you are approved for.

Do you expect to put a down payment of your own (thereby not financing the entire cost of the upgrades)?

Yes

No

Customer down payments are optional. However, if your project cost exceeds $5,000 after rebates are factored in, then check the box below and input the remaining balance in the following question that will pop up. For example, if your project costs $20,000 and you expect to receive $4,000 in rebates and a $5,000 payment plan, then put $11,000 below.

Does your project cost exceed $5,000 after rebates are factored in?

If yes, how much?

How many years would you like to pay the financed amount over? Value is not selected

Do you have any comments or questions for us?

As the property owner of record or tenant of the property owner of record of the Property listed above, I attest that the information that I have supplied in this application in order to be evaluated for participation in the San José Clean Energy EcoHome Payment Plan Pilot Program is all true and accurate. *

Signature

Household and Demographic Information

Please note that your answers to these questions will be kept confidential and do not impact your application in any way. Your responses will be anonymously combined with those from other applicants to help San José Clean Energy understand adoption of electrification and energy efficiency projects among City of San José residents and to improve future programs and offerings.

What is your household size? Number of people residing in your home

What is your annual household income? Value is not selected

What is your age? Value is not selected

What is your gender? Values are not selected

What is your race/ethnicity? Values are not selected

How did you hear about the San José Clean Energy EcoHome Payment Plan loan? (select all that apply) Values are not selected

This is the end of the San José Clean Energy EcoHome Payment Plan loan application. Before clicking "Submit Form" below, please note the following:

All email communications will come from askprograms@sanjoseca.gov
Submitting this application does not commit you to nor secure you to the payment plan. After your application is approved, we will email you a Loan Agreement which you will have 30 days to sign. The payment plan is only secured after that agreement has been signed.

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CSJCE - Energy Ecohome Payment Plan Loan Application

Customer Information

Employer Information

Project Information

Household and Demographic Information