New Jersey Comfort Partners Program

Application for Weatherization

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone (Primary) *

Phone (Secondary)

What is the best time to call?

Would you like to opt in for texts? *

Yes
No

Texts can be stopped at any time.

Phone *

Eligibility Information

Number of persons (residing in the household) *

Including children.

Is your gross annual income (before taxes) under $32,200 for everyone 18+ in the home?

Yes
No

If your annual income before taxes (everyone 18+ in household) is above this number, then you are not eligible at this time.

Is your gross annual income (before taxes) under $43,550 for everyone 18+ in the home?

Yes
No

If your annual income before taxes (everyone 18+ in household) is above this number, then you are not eligible at this time.

Is your gross annual income (before taxes) under $54,900 for everyone 18+ in the home?

Yes
No

If your annual income before taxes (everyone 18+ in household) is above this number, then you are not eligible at this time.

Is your gross annual income (before taxes) under $66,250 for everyone 18+ in the home?

Yes
No

If your annual income before taxes (everyone 18+ in household) is above this number, then you are not eligible at this time.

Is your gross annual income (before taxes) under $77,600 for everyone 18+ in the home?

Yes
No

If your annual income before taxes (everyone 18+ in household) is above this number, then you are not eligible at this time.

Is your gross annual income (before taxes) under $88,950 for everyone 18+ in the home?

Yes
No

If your annual income before taxes (everyone 18+ in household) is above this number, then you are not eligible at this time.

Is your gross annual income (before taxes) under $100,300 for everyone 18+ in the home?

Yes
No

If your annual income before taxes (everyone 18+ in household) is above this number, then you are not eligible at this time.

Unfortunately, you are not eligible at this time. Please visit NJCleanEnergy.com for additional programs.

Based on your answer regarding income.

Gross monthly income (all household residents ages 18+)

Before taxes are taken out.

Type of dwelling: *

1 - 14 Unit Dwelling
15+ Dwelling (not eligible)

Unfortunately, you are not eligible at this time.

If 15+ apartments are attached to your unit, you do not qualify at this time, please visit NJCleanEnergy.com for more assistance programs.

Check if you participate in:

HEAP
LIFELINE
PAAD
SECTION 8
SSI
TANF
USF
SNAP

Type of Heating Fuel: *

Natural Gas
Electricity
Oil
Other Fuel

Name of Electric Company: *

Electric Account Number:

Name of Gas Company: (if applicable) *

Gas Account Number:

Do you own or rent your home? *

Own
Rent (Landlord consent will be necessary)

How would you like us to send the Landlord Agreement?

Email
Mail

The Landlord Agreement is a form that is signed by the landlord consenting that the home be weatherized. At NO COST to the tenant and landlord.

Do you pay directly for your heating? *

Yes
No

If "No" then not eligible. Must be primary account owner.

Do you own your refrigerator? *

Yes
No, owned by landlord

Is your utility service currently active? *

Yes
No (Site visit cannot be scheduled until activated)

Unfortunately, you are not eligible at this time.

The utilities must be active to be eligible for the program.

Have you lived in your home for longer than 1 year?

Yes
No

If "No" then not eligible at this time.

Prior to scheduling, we require that you have lived in the home for 12 months. Please submit this application so that we may contact you when you are eligible.

If you would like us to contact you after you have lived in the home for 1 year, please provide your move in date below. If you would like to contact us, you may leave this section blank.

Was your home built more than 5 years ago? *

Yes
No

If "No" then not eligible at this time.

Is the home currently under construction, foreclosure, or for sale? *

No
Yes

If "YES" then not eligible at this time.

Unfortunately, you are not eligible at this time.

Homes have to be built more than 5 years ago due to builders warranty. Please visit NJCleanEnergy.com for additional programs.

Unfortunately, you are not eligible at this time.

IF the home is under construction, please apply once construction is complete. The home cannot be listed for foreclosure and/or for sale at the time of the audit. Please visit NJCleanEnergy.com for additional programs.

Have you ever had Comfort Partners or any other weatherization program before?

Yes
No
Unsure

Does your home have any of the following issues?

Roof leaks
Plumbing leaks
Sump pump issues
Smell of gas
Other

If other, please explain.

How did you hear about the program? *

Authorized Signature *

I certify that all information provided above is correct to the best of my knowledge, and I give the New Jersey Board of Public Utilities, NJ’s Clean Energy Program and participating New Jersey Comfort Partners utilities and contractors permission to: 1) share my records 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 understand that all work is guaranteed for a period of one year.

Date *

Thank you for completing the application, please click submit and the application will be sent to our office.

Phone

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