Verde Builds Heat Pump Interest Form

Verde Builds Heat Pump Interest Form

Thank you for your interest in special incentives through the Energy Trust of Oregon and Verde for a Ductless Heat Pump (DHP).

4145 NE Cully Blvd Portland, OR 97218

971-272-4126 (Hablo Español) / 971-468-8431 | dhp@verdenw.org

Name/Nombre*

Address/Direccion*

Phone/Telefono

email (list Phone if no email)*

Household size / Numero de Residentes en el hogar*

Full-time residents living in home / Residentes viviendo en el hogar tiempo completo

Select

Gross Annual Household Income / Ingreso anual del hogar antes de los taxes*

Yearly household income before taxes / Ingresos familiares anuales antes de los taxes

Energy Provider / Provedor de Energia

Select

Primary heating device/ Principal dispositivo de calentamiento*

** Please note that Verde has limited resources available to help with a functioning gas heat source.

** Tenga en cuenta que Verde tiene recursos limitados disponibles para ayudar con una fuente de calor de gas que funcione.

Select or enter value

Approximate Square Footage / Area

How did you hear about this? ¿Como escucho de este programa?

Notes / Notas

Send me a copy of my responses

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