Contact Information First Name * Last Name * Title * Email Address * Phone Number Mobile Company Name * Address Street Address * City * —Please choose an option—AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyoming ZIP/Postal Code * Business Information Your NAICS Code Number of Employees Annual Revenue Business Type * ProfitNon-Profit USA Owned or Foreign Owned * USA OwnedForeign Owned Do You Own or Lease Your Business Office(s)? * OwnLease Grant Information What Do You Plan to Use the Grant Funds For? (Select All Applicable) Solar PV.CEnergy EfficiencyOther Mounting Preference (If Applicable) GroundRoofN/AUnsure What Type of Roof Does Your Building Have? (If Applicable) ShingleMetal-CorrugatedMetal-Standing SeamFlat RoofTileN/AOther How Old Is Your Roof? (If Applicable) What Type of Roof Does Your Building Have? (If Applicable) ShingleMetal-CorrugatedMetal-Standing SeamFlat RoofTileN/AOther Misc. Information Are You Currently Serving as a Community/Public Leader? YesNoUnsure Are You Interested in Hosting a Workshop? YesNoUnsure
