South Jersey Gas - Smart Energy Partners
Address Line 1
Address Line 2
District of Columbia
What is the best time to call?
List name of spouse or other individual we can speak with
Gross monthly income (all household residents ages 18+)
Number of persons (residing in the household)
South Jersey Gas Account Number (if not on-hand, we will contact you)
Is your gas service currently active?
Type of dwelling:
Rent (Landlord consent will be necessary)
I certify that all information provided above is correct to the best of my knowledge. I give South Jersey Gas and Green Life Energy Solutions permission to: 1) share information regarding my home and energy usage with all parties planning to do work on my home or evaluate my energy usage; 2) use, at no charge, any description or pictures relating to the work performed at my home and 3) have reasonable access to my home to inspect the work performed. I acknowledge that an assessment of my dwelling is necessary to determine the work that can be performed and that the work that is available may be limited due to the needs and condition of my residence. Identified work may not be provided if it does not meet all program requirements and specifications and may lead to full or partial deferral of work. My refusal of certain work may prevent the installation of other identified work in accordance to program requirements.I hereby release and pledge to hold harmless South Jersey Gas and Green Life Energy Solutions, and its staff, from any liability in connection with the work conducted at my residence, except as a consequence of gross negligence or willful and wanton misconduct. I authorize the South Jersey Gas and Green Life Energy Solutions to review the previous year’s 1040 Federal Tax Form or W-2, along with my last four pay stubs.
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