Partner Company Name *

Rep Name *

Customer Last Name *

Customer First Name *

Customer's Phone *

Customer's Email *

Does Customer have a Inter-connection agreement?: *

Address

Customer's Address *

City

State

Country

Postal code

System Size / KW *

Date of Install *

Total System Price *

Total Adders

Is Customer In An Energy Community? *

Did They File Their 2024 Taxes? *

PURCHASE OR LEASE

Total Financed Amount *

If financed: Loan Term (# years)

If Financed: Monthly Payment

If financed: Interest Rate

If leased: Monthly Lease Payment

If leased: Escalator Rate

If leased: Lease Term (# years)

State Credit Amount (if any)

Midas Service Charge

Wage Type (1099 or W-2) *

Filling Status

Number of Dependents *

Social Security income (if any)

$

Disability income (if any)

$

Customer Stated Income *

Notes From Sales Rep