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First Name *

Last Name *

Phone *

DOB

Gross Monthly Income (Pre-Tax) *

Job Title or Are you Retired? *

Is the home free and clear? or is there a Mortgage? *

Estimated Credit Score *

Has the mortgage been paid on time for the past 12 months? *

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How long have you lived at your residence? *

Solar Rep Full Name *

Solar Rep Email *

Solar Rep Phone Number *

(OPTIONAL) Upload Solar Proposal

notes from the Rep on what the customer is interested in, the customers goals, and any other important pieces of information:

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