Energy Saver NC User Consent for
Contractor Assisted Customer Application

1. User Consent

I authorize the contractor to assist and guide me through the Energy Saver North Carolina application process. This includes helping me complete required documentation, upload necessary files, communicate with program administrators on my behalf, and support me in meeting all program requirements. I understand that this assistance is intended to help ensure the timely and accurate submission of my application.

2. Attestation

By submitting this application for award, the applicant hereby certifies that all information provided is true and accurate to the best of their knowledge. The applicant understands that any false or misleading statements may constitute fraud and could result in the denial of this award, as well as potential civil and criminal penalties. This includes, but is not limited to, the truthful and accurate reporting of total family income, number of household members, property ownership, property location, and performance of contractor services.

3. NC DEQ Application Terms and Conditions

North Carolina Department of Environmental Quality (NC DEQ) Application Terms and Conditions for HOMES and HEAR Programs

Effective: May 1, 2025

PLEASE READ THIS SECTION CAREFULLY:

My signature below authorizes Energy Saver NC Staff and Contractors to enter my home as needed to perform energy efficiency upgrades. My signature verifies that this residence is not currently for sale, nor is it designated for acquisition or clearance (foreclosure) by federal, state or local programs. Upon completion of work, I give permission for the contractor, sub-contractor staff, local, state, and/or federal officials to inspect said work.

I understand a final inspection of the work provided is necessary. I will be responsible for payment of services rendered if I refuse to allow work to be completed or the final inspection(s) of my home.

I understand program requirement regulations prohibit warranties as an allowable program expense. Materials and labor will be covered by the installer for one year. I agree, on behalf and for all members of my home, that the state of North Carolina, energy auditors, and it's sub-contractors will not be held liable for any injury or expense incurred by me while participating in this program. I attest to the best of my knowledge that the information on this form is correct and complete. This service is free of charge but if my home is served due to incomplete or incorrect information that would otherwise make my household ineligible, I accept responsibility for paying for services received. I authorize the release of income and benefits information to the Energy Saver NC program to document my eligibility. Pursuant to 5 U.S.C. 552(b)(6), of the Freedom of Information Act, the Energy Saver NC program is required to keep confidential any specifically identifying information related to an individual's eligibility application for weatherization services, or the individual's participation in weatherization services, such as name, address, or income information. The State of North Carolina in conjunction with the Energy Saver NC program may, however, release information about recipients in the aggregate in a manner which does not identify specific individuals.

Recertification of income information provided must occur every 12 months.

Client Appeals Process

Once you have completed the application for services, you have the right for your application to be processed within 60 days. If your application is not processed within 60 days or if you are denied services, you may appeal the decision using the following appeals procedure: You may appeal to the Program Manager of Energy Saver NC. Appeals to Energy Saver NC should be in writing and addressed to:

The office will have 15 days to respond in writing to all appeals and the decision will be considered final. If you are unsatisfied with the results of your appeal, you will be given the appropriate state or local contact information.

4. Equipment Removal Standards

By enrolling in this program, you acknowledge and agree that contractors are required to remove all uninstalled equipment from your property.

5. Conflict of Interest Consent

The Applicant represents that they are not employed, retained, paid a fee, or otherwise received or will receive any personal compensation or consideration from the Contractor as a result of the rebated Project other than publicly available rebates and discounts reflected on the Project invoice. The Applicant also represents that they and their family members do not have a direct or indirect financial relationship with the Contractor or the Implementation Team.

In the event that an Applicant is an employee of the State or Implementation Team or any other person with a financial interest in the completion of the Project, they will be excluded from any functions or responsibilities in the review or approval of the Project.

6. Consent to Use Photos

By enrolling in this program I do hereby consent and agree that the N.C. Department of Environmental Quality and affiliates have permission to take photographs and/or record video and/or audio of me and/or my property, or use the photos/video/audio I have provided, for use in educational, promotional, and/or marketing materials. I further consent that my name and identity may be revealed therein or by descriptive text or commentary. Neither individual addresses nor telephone numbers will be published within this material. I do hereby give the N.C. Department of Environmental Quality and affiliates the right to exhibit any such works publicly or privately, including posting on the N.C. Department of Environmental Quality website. I waive any rights, claims, or interest I may have to control the use of my identity or likeness in the photographs, video, or audio, and agree that any uses described herein may be made without compensation or additional consideration to me. I represent that I have read and understand the foregoing statement and that I am competent to execute this agreement.

7. Referral Consent

Want to make your home more energy-efficient and save money? By giving consent, we can connect you with trusted partners offering:

• Home repairs and weatherization
• Rebates and energy upgrades
• Assistance programs and future opportunities

Important: We'll share your contact information (name, address, phone, email) only with the partners you choose. A referral does not mean we endorse any partner. You can change or remove consent anytime without affecting your Energy Saver NC eligibility.

Information That May Be Shared

When you opt in to a referral program, the following contact information may be shared with the selected partners:

• Your name
• Your address
• Your phone number
• Your email address

Your Referral Selections

You may choose to opt in to any of the following referral programs:

• Home Repair/Weatherization Programs (i.e. Habitat for Humanity, WAP)
• Registered contractors in Energy Saver NC program
• Nonprofits or community groups that help with energy or housing
• Utility rebate programs
• Updates about future programs that could help me

A referral does not mean we endorse any partner. You can change or remove consent anytime without affecting your Energy Saver NC eligibility. Your preferences can be updated in the Terms & Conditions section of your dashboard.