Partner Company Name

Sales Rep *

Sales Rep Phone Number *

First Name *

Last Name *

Phone *

Email *

Does Customer Have an Inter-connection Agreement? *

Address

Street Address *

City *

State *

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? *

Are There Any Other Systems On The Property? *

Cash Or Finance? (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

Applicable Documents

Finance Agreement (If Applicable), Install Agreement

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