New Equipment and Construction EC Motor Incentive NEC EC Motor Incentive Form 2018 Step 1 of 2 50% Section A: CUSTOMER INFORMATIONCustomer Name * Required First Last Facility Address * Required Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is this the mailing address? * Required Yes No Mailing Address * Required Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Electric Account Number * Required Rate * Required Application Number Service Location Identification Email * Required Contact Person * Required First Last Title * Required Phone * RequiredIncorporated * Required Yes No Exempt Incentive Payment Preference * Required Check Bill Credit Pay Contractor Please Assign Payment to Contractor Customer SignatureAdditional Information Section B: CONTRACTOR INFORMATIONContact Person * Required First Last Contact Title * Required Contractor Name * Required Contact Person Signature Mailing Address * Required Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email * Required Phone * RequiredAdditional Info Incorporated * Required Yes No Exempt Section C: DOCUMENT APPROVALSBy signing and dating below, customer accepts this Incentive offer and agrees to the Utility Terms and Conditions available from your Utility. Pursuant to a Commission order, customers also agree that the utility alone may capture all kW and kWh savings and any ISO-NE capacity payments resulting from this energy efficiency project. This agreement is contingent upon continued approval and authorization by the Commission to recover said amounts from the System Benefits Charge. The Incentive, in conjunction with all other sources of funding, cannot exceed the total project cost.Customer Signature Date - must be mm/dd/yyyy format MM slash DD slash YYYY NE&C EC Motor Incentive WorksheetROW 1System Type * RequiredRefrigerationHVACFan Load * RequiredkW for Refrigeration/CFM for HVACEvap Fan Controls * RequiredYesNoAnnual Hours * RequiredQuantity of Motors * RequiredTotal IncentiveWould you like to submit another? Yes No ROW 2System Type * RequiredRefrigerationHVACFan Load * RequiredkW for Refrigeration/CFM for HVACEvap Fan Controls * RequiredYesNoAnnual Hours * RequiredQuantity of Motors * RequiredTotal IncentiveWould you like to submit another? Yes No ROW 3System Type * RequiredRefrigerationHVACFan Load * RequiredkW for Refrigeration/CFM for HVACEvap Fan Controls * RequiredYesNoAnnual Hours * RequiredQuantity of Motors * RequiredTotal IncentiveWould you like to submit another? Yes No ROW 4System Type * RequiredRefrigerationHVACFan Load * RequiredkW for Refrigeration/CFM for HVACEvap Fan Controls * RequiredYesNoAnnual Hours * RequiredQuantity of Motors * RequiredTotal IncentiveWould you like to submit another? Yes No ROW 5System Type * RequiredRefrigerationHVACFan Load * RequiredkW for Refrigeration/CFM for HVACEvap Fan Controls * RequiredYesNoAnnual Hours * RequiredQuantity of Motors * RequiredTotal IncentiveAttached Vendor quote * RequiredMax. file size: 1 GB.HiddenSection BreakMotor Grand TotalCAPTCHA