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Financial Inquiry for City of Duluth Utility Energy Conservation Loan Program

The information provided on this form is for the purpose of determining eligibility for the City of Duluth Utility Energy Conservation Loan Program. You are not required by law to answer all the questions on this form, but the answers will assist the Department of Public Works and Utilities in evaluating your application. Information provided will be used only by the Department of Public Utilities, and shall remain confidential.
You are required to have loan payments deducted from a valid checking account.

Project & Confirmation Information

Project Information: Home Energy Loans can be used for several instances as long as the project has an appropriate payback period.*
Furnace or boiler upgradeGas furnace or boiler conversion installationFailed furnaceInsulation upgradesLateral water or sewer line replacement
Conservation Information: The Home Energy Loan can be paired with other programs and rebates that ComfortSystems offers. Please select all programs of interest or that you are already participating in.
Advanced Home Energy auditWater or sewer line grantHigh efficiency boiler or furnace rebateREUPComfort Policy
An Advanced Home Energy Audit is a walk-through energy inspection. Providing a simple payback analysis on recommended conservation or efficiency measures that cost over $100, notification of potentially hazardous situations and unsafe appliance options, analysis of energy use patterns, blower door tests, thermal scans to identify building air leaks and insulation needs.
Water and Sewer lateral line replacement grants may be available to assist with the cost or your replacement.
This program offers a rebate directly from ComfortSystems when you are looking for a new high efficiency boiler or furnace. When you buy a new high efficiency boiler or furnace from one of our trade partners and it is installed within the ComfortSystems service territory, you get a rebate from $50 to $200, depending on the efficiency of the unit. To qualify for the rebate, the unit installed must be on the ComfortSystems' rebate equipment list. Boiler at 83.5% and greater AFUE is eligible for $50 rebate. Boiler at 90% or greater AFUE is eligible for $200 rebate. Furnace at 90% and greater AFUE is eligible for a $200 Rebate.
REUP - ComfortSystems, Minnesota Power, and Ecolibrium3 have partnered to introduce an energy efficiency program designed for small rental properties. Potential Participants: Property owner or landlord who own or manages a two, three, or four-unit rental property that rent to income qualified households. Grants are only available for properties that require a split of their mechanical systems. Grants are 50% up to the maximum value listed below for qualifying upgrades and the equipment must be over 90% efficient. Insulation and Air Sealing: - Free weatherization and air sealing services are available. Grants are also available for qualifying professional air sealing and insulation projects. Ask Ecolibrium3 about their Giving Comfort at Home program.
The Comfort Policy is an inexpensive extended service plan option. Our experienced service technicians can help detect potential problems and replace worn parts before they have a chance to create a major costly breakdown. Most parts and labor are covered at no extra charge. To be eligible for a Comfort Policy an inspection is required to ensure that the furnace has been cleaned within the past 12 months, is in reasonable condition, and that it is no longer under warranty. That visit will also include a brief explanation of the covered parts and services. If it is determined that a cleaning is required, a separate appointment must be scheduled and a service fee will apply. Once your Comfort Policy is active, you are eligible to receive an annual free maintenance checkup during the policy year to keep your heating unit in top running condition and keep it in compliance with the terms and conditions of the Comfort Policy program.

Section A - Information Regarding Applicant

Name:*
Social Security Number*
Birthdate*
Present Address*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Years There*
Email*
Confirm Email*
Phone Number:*
Previous Address:*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Cell Phone Number*
Current Employer*
Year of Employment with Current Employer*
Position Title*
Employer's Address*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Employers Phone Number*
Name of Supervisor*
Present Salary or Commission $*
Frequency of Payment*
Previous Employer (if less than 3 years at present job)
Previous Employer's Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Years of Employment with Previous Employer
Number of Dependents*
Alimony, child support or separate maintenance income do not need to be included if you do not wish to have it considered for repayment of loan.
Other Income $
Frequency of Payment
Source(s) of Other Income
Is any income listed in this section likely to be reduced before the credit request is paid off?*
YesNo
If "Yes", Explain in Detail*
Total Monthly Income $*
Checking Account Location*
Savings Account Location*
Name of Nearest Relative Not Living with You*
Relationship*
Relatives Address*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Relatives Phone Number*

Section B - Martial Status

Applicant*
MarriedSeperatedUnmarried (including single, divorced and widowed)
Spouse Name:*
Birthdate*
Social Security Number*
Phone Number*
Current Employer*
Employer Address*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Position Title*
Salary*

Section C - Information Regarding Joint Applicant

Would you like to add a joint applicant other than your spouse?
YesNo

Joint Applicant
MarriedSeparatedUnmarried (including single, divorced, and widowed)
Name*
Social Security Number*
Birthdate*
Present Address*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Years at Present Address*
Phone Number*
Previous Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Email*
Cell Phone Number*
Current Employer*
Years of Employment with Current Employer*
Position Title
Employer's Address*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Employers Phone Number*
Name of Supervisor*
Present Salary or Commission $*
Frequency of Payment
Previous Employer (if less than 3 years at present job)
Previous Employer's Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Years of Employment with Previous Employer
Number of Dependents*
Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Other Income $
Frequency of Payment
Source(s) of Other Income
Is any income listed in this section likely to be reduced before the credit request is paid off?*
YesNo
If "Yes", Explain in Detail*
Total Monthly Income $*
Checking Account Location*
Savings Account Location*
Name of Nearest Relative Not Living with You*
Relationship*
Relatives Address*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Relative's Phone Number*

Section D - Asset & Debt Information

Cash*
Boats/Automobiles - Please list the following: Make, Model, Year, Value, Subject to Debt, and Owners Name*
Make, Model, Year, Value, Subject to Debt, and Owners Name
Other Assests - Please list the following: Other Assets, Value, Subject to Debt, and Owners Name*
Other Assets, Value, Subject to Debt, and Owners Nam
OUTSTANDING DEBTS (Include charge accounts, installment contracts, credit cards, rent, mortgages, etc.)
Mortgage Accounts - Please list the following: Account, Name on Account, Original Debt, Current Balance, Monthly Payment, and if it is past due*
Account, Name on Account, Original Debt, Current Balance, Monthly Payment
Home Equity Accounts - Please list the following: Home Equity Accounts, Name on Account, Original Debt, Current Balance, Monthly Payment, and if it is past due*
Home Equity Accounts, Name on Account, Original Debt, Current Balance, Monthly Payment, Is it Past Due?
Other Loans - Please list the following: Creditor Name, Name on Account, Original Debt, Current Balance, Monthly Payment, and if it is past due*
Other Loans, Name on Account, Original Debt, Current Balance, Monthly Payment and if it's past due.
Revolving Credit - Please list the following: Creditor Name, Name on Account, Original Debt, Current Balance, Monthly Payment, and if it is past due*
Creditor Name, Name on Account, Original Debt, Current Balance, Monthly Payment and if it's past due.
Are you the co-maker, endorser or guarantor on any loan or contract?*
YesNo
If Yes, For Whom?*
To Whom?*

Section E - Property to be Improved

Address*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Year Built*
Date Purchased*
Type*
Number of Units*
Has the structure been occupied as a residence for the last 18 months?*
YesNo
Do you have any Home Equity Loans on Property to be Improved?*
YesNo
If Yes, with whom?*
Address*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Present Balance $
Complete Applicable Category*
Is OwnedIs Bought on Contract

Name*
Mortgage Holder*
Date of Mortgage*
Original Balance*
Present Balance*
Present Value*
Monthly Payment*

Name*
Name of Seller*
Sellers Address*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Name of Lienholder*
Lienholder's Address*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Date of Contract*
Price Paid*
Present Balance*
Present Value*
Monthly Payment*

Document Upload

Please attach any income verification documents, energy audit if you had one completed, two estimates for the work that will be done to the property if you have them.

Important - Applicant Must Read Before Signing

THE SELECTION OF A CONTRACTOR OR DEALER, ACCEPTANCE OF MATERIALS USED, AND WORK PERFORMED IS YOUR RESPONSIBILITY. THE CITY DOES NOT GUARANTEE THE MATERIAL OR QUALITY OF THE WORK PERFORMED.
I (We) certify that the above statements are true, accurate and complete. This application shall remain the property of the City to which submitted for the purpose of obtaining a loan.
I (We) authorize the City of Duluth - Department of Public Works and Utilities to obtain consumer credit report and verify that information. The information that the City of Duluth - Department of Public Works and Utilities obtains is only to be used to process my (our) application for a Home Energy Loan.
Please click “Sign” to complete your electronic signature. By checking the “I Accept” button, you are signing the application electronically. You agree that your electronic signature is the legal equivalent of your manual signature and consent to be legally bound by this application.
Do you accept these terms?*
I Accept
Applicant Signature*
Joint Applicant Signature
Dated

Form title

Financial Inquiry for City of Duluth Utility Energy Conservation Loan Program

Project & Confirmation Information

Section A - Information Regarding Applicant

Section B - Martial Status

Section C - Information Regarding Joint Applicant

Section D - Asset & Debt Information

Section E - Property to be Improved

Document Upload

Important - Applicant Must Read Before Signing