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2. 1. Home
   2. Business

   If both, please fill out one application for each.
4. First Name
5. Middle Initial
6. Last Name
8. Business / Organization
10. Address
12. Greenville, TX
13. Zip Code
15. Phone Number
16. Alternate Phone
18. E-mail
20. Address Where Product Installed

    If the installed location is different than the billing address. Please complete this field.

22. City
23. State
24. Zip Code
26. Add Attachment

    Proof of purchase required. Attach receipt here.

28. Add Attachment

    Proof of purchase required. Attach receipt here.

30. Plan to participate in

    1. Lighting
    2. Holiday Lighting

    1. Thermostat
    2. Appliance

    1. Attic Insulation
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit Submit and Print

* indicates a required field