Please fill out each section and attach the required documentation. Any questions can be directed to member services at (208) 743-1501. Member / Customer InformationName* First Last CPC Account Number*Service Address* Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone*Email Home Heating Information Must be Electrically HeatedHeating* Electric Furnace Electric Zonal Heat Pump Original Window Type* Single Pane Double Pane w/Metal Frames Date of Installation Total Square Footage of Windows Removed*(If unknown, please enter the name and phone number of the contractor who installed the windows)Total Cost of Window Project(If unknown, please enter the name and phone number of the contractor who installed the windows)Brand (Manufacturer) of New Windows*(If unknown, please enter the name and phone number of the contractor who installed the windows)Model of New Windows*(If unknown, please enter the name and phone number of the contractor who installed the windows)Supporting Documents*Invoices / Receipts; Pictures of Electric Heat Source; Pictures (before & after); Drop files here or Select files Max. file size: 100 MB.
