OUACHITA ELECTRIC HELP PAYS ONLINE ENROLLMENT FORM

Today's Date*

First Name*

As it appears on the Ouachita Electric account

Last Name*

As it appears on the Ouachita Electric account

Enter the first and last name of other occupant or spouse*

Property Address*

Property City*

Select

Property Zip Code*

Mailing Address*

Mailing City*

Mailing State*

Mailing Zip Code*

What phone number are we most likely to reach you?*

Please enter phone numbers as you would write it and not just one long number. EX: 999-999-9999

Phone 2

Email

If you have an email address please list it here.

Property Ownership*

Do you own or rent your home? OECC requires property owners to have a current insurance policy. At the end of this form you will be asked to load the current insurance policy.

Own

Rent

Mobile Home Land Ownership

If Mobile Home, Do you own the land where your mobile home is located?

Yes

No

Since mobile homes can be relocated, HELP PAYS is not available for any mobile homes not fixed to a permanent foundation, and/or built prior to 1995. Does your home have a permanent foundation?

Select

Home sqft*

Enter the square footage of your home to the best of your knowledge.

What year was your home built or manufactured? (Ex: 1995, not 20 years old)*

How do you primarily cool your home?*

Central Air

Window Units

Ceiling Fans

How many central heating and cooling systems do you have?*

0

1

2

3

If you have a central heating and cooling system, is it operational?*

Approximate age of your Central Heating and Cooling System?

1-5 years old

6-10 years old

10+ years old

If your central air and/or central heat is not operational, how long ago did it stop working?

Is your home currently under renovation with missing ceilings/flooring/walls/windows

Yes

No

Do you have internet service/Wi-Fi in your home today?

Yes

No, never will

No, but please send me information on internet availability for my area

Preferred HVAC Contractor

If you would like a free quote for a new heating and cooling system, please select one of our approved HVAC Contractors below.

Deans Heating and Air

Hampton Heat and Air

Keithley Heating and Air

No HVAC Quote Needed

Friend/Family Referral

If you were referred by a friend or family member, please list their name here if you don't mind sharing. Thank You!

Ouachita Electric Employee Referral

If you were referred by an employee of Ouachita Electric, please list their name here.

Participation Reason

Please select from options below that best describes the reason you have signed up for Ouachita HELP PAYS.

Solar Inquiry*

If you would like information about Solar opportunities for your home please select "YES" below.

Yes

No

Comments

Enter any kind of special notes or instructions here.

Release of Energy Usage

To establish a baseline from which to evaluate your home's potential for energy savings through Ouachita Electric Cooperative's HELP PAYS Program, you understand and consent to share past and present energy use from your home with all affiliated implementers, assessors, and contractors, to access solely and strictly in support of the program. By answering "Yes" you are giving consent.

Yes

Propane Usage in Gallons

If you use Propane in your home, please tell us how many gallons a year you use. If you are not sure how many gallons but know how much money you spend then divide the annual dollar amount by $2.09 (or the rate per gallon you paid) and that will give you the gallons.

Natural Gas Usage and/or Homeowners Insurance Policy

If you have natural gas with CenterPoint, please contact them to acquire your last 12 months worth of usage and upload it in the link or drop it off at the Ouachita Electric Office. DOES YOUR HOME HAVE A CURRENT HOME OWNERS POLICY IN EFFECT? OECC requires property owners to have a current insurance policy on the residence. Please upload your current insurance policy in the link below.

Drag and drop files here or

Send me a copy of my responses