Home and Contact Information

This application is for existing Michigan primary residences installing a ductless mini split heat pump system.

Full Name

Phone *

Email *

Address

City

State

Have you received any government assistance programs 2024/2025?

SNAP or FAP
Medicaid Healthy Michigan or MIChild
SSI or SSDI
SER State Emergency Relief
Income Below Median (1040)
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This is my primary residence

Yes it is

Home Eligibility Requirements

Certain conditions must be met before an assessment can be scheduled.

Is your current heating system operational?

Yes

No

Can you provide 12 months of electric utility usage?

Yes

No

Are attic and mechanical areas accessible?

Yes

No

Are there unresolved major health or safety issues ?

Yes

No

Utility Information

Gas utility provider if applicable

Electric utility provider

Consent

I understand work cannot begin before program pre approval *

I understand

I authorize LivSmart to share required project information with program administrators *

I authorize

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