Heat Pump Application
To reserve your zero-cost water heater, please fill out the grant application. There is a limited amount of funds available. There is no repayment, loans, or lien through this program. We will also need to perform an onsite inspection per the requirements of the program rules. Please have the most current electric bill when we arrive for your appointment.
First Name
Last Name
Email
Phone Number
Address
Choose Your Current Electricity Provider
Select an option
So Cal Edison (SCE)
PG&E
SDG&E
LADWP
Bulding Type
Select an option
Single Family Home
Townhome
2 to 4 Unit Complex Rentals
5 + Unit Complex Rentals
Mobile / Manfactured Home
Commercial Building
How Many Bedrooms
How Many Bathrooms
Current Water Heater Type ?
Select an option
Tank Water Heater
Tankless
Unsure
Current Water Heater Fuel Type ?
Select an option
Natural Gas
Electric Resistance
Proprane
Not Sure
Other Electric Technologies On site ? Check All That Apply
None
Solar
Battery Backup
EV Charger (level 1)
Ev Charger ( level 2)
Back-up Generator
Are You Currently Receiving The Following? Extra incentives for income qualified customers
None
CalFresh (snap)
Supplemental Security Income (SSI)
Federal Supplemental Nutritional Assistance Program (SNAP)
CalWorks
Other
Your Signature
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Date
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