Self Scheduling

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I’d like to schedule a no-cost Helping Neighbors appointment

I'd like to reschedule or cancel my appointment.

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First Name *

Last Name*

Email*

Best Phone*

Is this a Mobile Phone

Alternate Phone

Service Zip *

What type of home do you have?*

What type of fuel do you use to heat home?*

What type of fuel does your water heater use?*

Does your home have a basement?

Do you own or rent?*

How did you hear about this program?*

Did you receive a promotional code?

ELIGIBILITY

This Program is valid for residential customers only. In order to be eligible, customers must utilize natural gas or combined natural gas and electric distribution service from Consumers Energy. Any/all direct install measures offered by this program may be installed if the Energy Technician determines that energy savings will result. Measure eligibility depends on utility services provided by Consumers Energy.

INFORMATION RELEASE

Customer agrees that the utility provider(s) may include customer’s name, address, utility provider(s) account number, utility provider(s) services and resulting energy savings (“information”) in a database hosted by a contractor of utility provider(s) and such information may be included in reports or other documentation submitted to utility provider(s), and/or the Michigan Public Service Commission (“Reports”). Utility provider(s) will treat such information as confidential.

If you have entered a mobile phone number, or another number that you later convert to a mobile phone number, you agree that we may contact you at this number. You also agree to receive calls and messages such as pre-recorded messages, calls and messages from an automated dialing systems, or text messages. Normal mobile phone charges may apply.

APPROVAL, VERIFICATION AND INSPECTION

The utility provider(s) reserve(s) the right to verify all measures.

LIMITED TIME AND FUNDING

The program has a limited time and budget. The utility provider(s) has the right to discontinue Program at any time without notice.

LIMITATION OF LIABILITY

IN NO EVENT WILL UTILITY PROVIDER(S) BE LIABLE WHETHER IN CONTRACT, TORT (INCLUDING NEGLIGENCE), STRICT LIABILITY, WARRANTY OR OTHERWISE FOR SPECIAL, INCIDENTAL OR CONSEQUENTIAL DAMAGES CONNECTED WITH OR RESULTING FROM PARTICIPATION IN THE PROGRAM.

DISCLAIMER/WARRANTY

Neither utility provider(s) nor any of its affiliates guarantees the energy savings or makes any warranties associated with the measures eligible under this program. The utility provider(s) has no obligations regarding, and does not endorse or guarantee any claims, promises, work, or equipment made, performed, or furnished by any contractor or equipment vendor that sells or installs any energy efficiency measure. The utility provider(s) makes no warranties or representations of any kind, whether statutory, expressed, or implied, including without limitations, warranties of merchantability or fitness for a particular purpose regarding the manufacturer or vendor. In no event shall utility provider(s) or CLEAResult be liable for any incidental or consequential damages.

PROPERTY RIGHTS

The customer represents that the customer has the right to permit the installation of efficiency measures and that any necessary landlord’s consent has been obtained.

I understand and accept the terms and conditions.

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Confirmation Number*

Last Name*

Zip Code*

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Unit Type

Location of Unit

Configuration of Unit

Did you replace the appliance to be recycled?

Add Unit

Unit Type	Location of Unit	Configuration of Unit			replaced the appliance to be recycled
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Payee's First Name

Payee's Last Name

Street 1

Street 2

City

State

Zip

Is the refrigerator and/or freezer emptied,defrosted and wiped out of foreign matter?

I agree I am the owner of all appliances to be recycled.

I understand that I must provide a clear and safe path with access to all units as pickup crews are not equipped to move items in or around the unit.

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Submit Unit(s)

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Please answer the following program qualifying question.

Number of people in your household

For last year, was the total annual income for your household $91,000.00 or less?

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Gas Utility Copy information from the previous page

Gas Utility Account #

Account Holder First Name*

Account Holder Last Name*

Details about your home

Service Street # *

Service Street Name *

Service Apt #/ Lot#/ Unit #

City*

State*

Zip*

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Helping Neighbors Program Eligibility is based on:

Receiving natural gas or combination (natural gas + electric) service from Consumers Energy
Residing in a single family home, condo, manufactured home, or 2-4 unit apartment building
Meeting income eligibility requirements

Based on the information provided, it appears you are ineligible at this time.

For customers who exceed income eligibility requirements, our Home Energy Analysis Program may still be able to help.
Visit HomeAnalysis-ConsumersEnergy.com/schedule

If you think you received this message in error, or have any questions, please contact us at 877-448-9433.

We also invite you to visit our Residential Assistance page for Consumers Energy Assistance Resource Guide and additional services.

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What's a good time for us to visit?

Based on your choice, plan for for a detailed audit for your home. Please select the best time for us to visit by selecting one of the available appointments in green in the calendar below. If you would like to see our availability in a future month please use the arrows on the top to navigate back/forth between months. Please call 877-488- 9433 if you don’t see an available appointment.

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Confirmation Number:
Your appointment is booked for .

Thank You

Number of household members	Maximum Income
1	$23,760
2	$32,080
3	$40,320
4	$48,600
5	$56,880
6	$65,160
7	$73,460
8	$81,780
add $8,320 for each additional household member

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