Get Energy Right Program Heat Pump 2005-2025

Energy right Program CEMC FAX 931-221-4035 Heat Pump Loan Application Applicant/Co-Applicant Information New Home Retrofit If Applicable c Applicant s Name Applicant must be the legal owner of home where heat pump is to be installed. Landlord Manufactured Home SS - Date of Birth / Applicant Mailing Address Co-applicant Mailing Address Street Address City State ZIP Home Phone Work Phone d de Driver s License d To help the government fight the funding of terrorism and money laundering activities Federal law including the USA PATRIOT Act requires all financial institutions to obtain verify and record information that identifies each applicant. Applicant Previous Address if at present address less than 3 years Co-applicant Previous Address if at present address less than 3 years Installation Address if different from applicant mailing address If the home is a manufactured home and the applicant does not own the land where the home is located the name of the land owner is Power Distributor Name Cumberland Electric ID Customer Number QCN Member Name by QCN Member Representative Signature Loan Request Heat Pump Type Total Installed Cost Split Package Advanced Check all that apply Number of units Interest Rate Weatherization Other Please describe By signing Applicant s certify 1 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 Applicant s understand s that Applicant s must provide and maintain satisfactory security arrangements for the program financing and for financing heat pump s in a new home Applicant s have not and will not mortgage more than 85 of the value of the new home. 2 Applicant s reveal s any outstanding balances for any prior heat pump financing. Loan request reflects the maximum amount allowed reduced by any outstanding amount for existing loans administered by any TVA power distributor. 3 Applicant s understand s that providing a social security number is not required to be considered for program financing but will assist in making an informed judgment concerning Applicant s application and is needed to expedite consideration of the application* 4 Everything Applicant s have stated in this application is correct to the best of my knowledge. Applicant s 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 my credit experience. Applicant s Signature Date Co-Applicant s Signature Bank Use Only Loan Approved Loan Declined e Loan Approval Number A photocopy of a government-issued photo ID is required to complete the loan*. Applicant Previous Address if at present address less than 3 years Co-applicant Previous Address if at present address less than 3 years Installation Address if different from applicant mailing address If the home is a manufactured home and the applicant does not own the land where the home is located the name of the land owner is Power Distributor Name Cumberland Electric ID Customer Number QCN Member Name by QCN Member Representative Signature Loan Request Heat Pump Type Total Installed Cost Split Package Advanced Check all that apply Number of units Interest Rate Weatherization Other Please describe By signing Applicant s certify 1 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 Applicant s understand s that Applicant s must provide and maintain satisfactory security arrangements for the program financing and for financing heat pump s in a new home Applicant s have not and will not mortgage more than 85 of the value of the new home. 2 Applicant s reveal s any outstanding balances for any prior heat pump financing. Loan request reflects the maximum amount allowed reduced by any outstanding amount for existing loans administered by any TVA power distributor. .