Home and Contact Information

This application is for existing Michigan primary residences installing heat pump system.

Full Name *

Phone *

Email *

Address *

Street Address *

City *

State *

Postal Code

Have you received any government assistance programs 2024/2025? *

Are you the homeowner? *

Yes

Home Eligibility Requirements

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

How many people live in your home? *

Monthly Household Income? *

Is your current heating system operational?

Yes

Are attic and mechanical areas accessible?

Yes

Are there unresolved major health or safety issues ?

Yes

Do you heat your home with natural gas? *

Yes

Natural Gas Provider *

Natural Gas Provider Account Number *

Electric Utility Michigan *

Last 4 of Social (This is a compliant and secure submission) *

I understand work cannot begin before program pre approval *

I understand

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

I authorize