EAGER JQUERY

Home Winterproofing Program Application Form

* Indicates required fields
  • 1) Account Number >
     

     
     

     
     

     
     

     
     

    (Please enter with no spaces)

     
     

     
  • 2) Tell us about you - Customer Contact Information >
     

     
     

     
     

     
     

     
     

     
     

     
     

     
     

     
     

     
     

     
     

     
     

     
     

     
     

     
     

     
     

     
     

     
     

     
     

     
     

     
     

     
     

     
     

     
     

     
  • 3) Tell us about your home >
     

     
     

     
     

     
     

     
     

     
     

     
     

     
     

     
     

     
     

     
     

     
     

     
     

     
     

     
     

     
     

     
     

     
     

     
     

     
     

     
  • 4) Eligibility criteria for the program >


    Your household has benefited from one or more of the following programs:











    Your total gross adult household income does not exceed the following eligibility limit (requires income validation):









     

     
     

     
  • 5) Applicant Certification >


    I understand that my rent cannot increase as a result of this program. I understand that information provided by me will be used solely for program purposes and will otherwise be kept confidential. I will provide documentation confirming income eligibility to the Delivery Agency (not necessary when application is completed by a referring agency).

    I give permission to ENBRIDGE GAS, Participating sponsors and program contractors to:

    • verify income or benefits received by my household for purposes of confirming eligibility
    • conduct an energy audit of my home at no cost to me
    • provide advice and perform energy efficiency upgrades to my home at no cost to me
    • use photocopies of this signed release for these purposes
    • contact me or my case worker
    • obtain natural gas consumption records from Enbridge Gas for up to 3 years before and after the work is done for the program verification and evaluation process
    • randomly choose me to participate in a Quality Assurance/Quality Control assessment
    • share customer information that pertains to related programs to further assist me with energy efficiency

    *Delivery Agents will obtain signature

    I give permission for the companies listed below to contact me in regards to the Home Winterproofing Program and other marketing lists. By checking this box, I agree to receive offers, promotions, and other communications from Enbridge Gas and its partners. I may unsubscribe from these communications at any time.

    Enbridge Gas
    500 Consumers Road
    North York, ON M2J 1P8
    1 877-362-7434
    www.enbridgegas.com

    GreenSaver
    74 Six Point Road
    Etobicoke, ON M8Z 2X2
    T: 416-203-3106
    T: 1-888-855-3106 (Toll Free)
    F: 416-203-3121
    F: 1-888-777-8416 (Toll Free)
    info@greensaver.org
    www.greensaver.org

    Windfall Centre
    93A Industrial Parkway S.
    Aurora, ON L4G 3V5
    T: 905-727-0491 (local # – Aurora)
    T: 705-243-1879 (local # – Peterborough)
    T: 1-866-280-4431 (Toll Free)
    F: 289-648-4106
    applications@windfallcentre.ca
    www.windfallcentre.ca

    EnviroCentre
    326 Somerset Street W.
    Ottawa, ON K2P 0J9
    T: 613-656-0100
    T: 1-877-580-2582 (Toll Free)
    F: 613-562-3361
    enviro@envirocentre.ca
    www.envirocentre.ca

    Green Venture
    22 Veevers Dr.
    Hamilton, ON L8K 5P5
    T: 1-866-540-8866 ext. 115
    F: 905-540-8882
    winterproofing@greenventure.ca
    www.greenventure.ca

    The Home Inspectors Group
    Unit 2 - 400 Esna Park Drive
    Markham, ON L3R 3K2
    T: 647.792.0276
    T: 866.907.9206
    hwp@thehomeinspectorsgroup.com
    www.thehomeinspectorsgroup.com