Partner Company Name

Sales Rep *

Sales Rep Number *

First Name *

Last Name *

Phone *

Email *

Does Customer Have an Inter-connection Agreement? *

Address

Street Address *

City *

State *

Country

Postal Code *

System Size / KW *

Projected Date Of Activation/PTO *

Total System Cost *

Total Adders

Is Customer In an Energy Community? *

Did They File Their 2025 Taxes? *

Cash Or Finance? *

Total Financed Amount *

Monthly Payment: *

$

Loan Term (# years): *

Interest Rate: *

Are There Any Other Systems On The Property? *

Cash Or Finance? (2nd System) *

Total Cost: (2nd System) *

$

Financed Amount: (2nd System) *

Monthly Payment: (2nd System) *

$

Loan Term: (2nd System) *

Interest Rate: (2nd System) *

State Credit Amount (if any)

Midas Service Charge

$

Wage Type (1099 or W-2) *

Tax Filing Type *

Number of Dependents *

Disability income (if any)

$

Social Security income (if any)

$

Customer Stated Income *

Years of Service *

Who Will Be Paying The Invoice? *

Notes From Sales Rep