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energy right ® ProgramHeat Pump Loan Application |
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Applicant/Co-Applicant Information |
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o New Home o Retrofit |
If Applicable: o Landlord o Manufactured Home |
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* Applicant’s Name ___________________________________________ SS# _______________________ Date of Birth ________________(*Applicant must be the legal owner of home where heat pump is to be installed.) Co-Applicant’s Name _________________________________ SS# ___________________________ Date of Birth _____________________ Installation Address: Mailing Address (If different): Street Address _______________________________________ Street Address _________________________________________ City ________________________________________________ City _____________________________________________ State ______________ Zip _________________ State ___________ Zip ____________ Home Phone (____) __________________________ Work Phone (____) _____________________________________ (Please return with copy of driver’s license of all applicants)
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Power Distributor Information |
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Power Distributor Name Tullahoma Utilities Board______________________ ID# __224___________Customer Number _________________________________ QCN Member Name __________________________________ ID# _____________ by _______________________________(QCN Member Representative Signature) |
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Loan Request |
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Heat Pump: Brand: ___________ Tonnage: ______ Type: Split Package Advanced# Number of units__________ Interest Rate___________ Ductwork: Wiring: Weatherization: Other (Please describe): _______________
Total Installed Cost: |
$ ____________________________________
$ ____________________________________ $ ____________________________________ $ ____________________________________ $ ____________________________________
$ ____________________________________ |
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By signing, Applicant(s) certify: (1) for financing heat pump(s) in a new home I have not and will not mortgage more than 85% of the value of the new home; I understand that the program financing will involve security arrangements which may make it more difficult to obtain construction financing, permanent (1st mortgage) financing, or other financing for the new home; and I understand that I must provide and maintain satisfactory security arrangements for the program financing. (2) No work for which financing is requested has been started, and I have informed the QCN member of any outstanding amount I owe on a distributor/TVA Heat Pump Program loan. (3) I understand that providing my social security number is not required to be considered for program financing, but will assist in making an informed judgment concerning my application and is needed to expedite consideration of my application. (4) Everything that I have stated in this application is correct to the best of my knowledge. I understand that you will retain this application whether or not it is approved. You are authorized to check my credit and employment history and to answer questions about your credit experience with me. Applicant’s Signature ________________________________________________________ Date _________________________ Co-Applicant’s Signature _____________________________________________________ Date _________________________ |
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Bank Use Only |
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Loan Approved ________________ Date ___________ Loan Approval Number ___________ Loan Declined _________________ Date ___________ |
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