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Energy Service Provider Form
for Submitting A Success Story or Award

Applications are accepted year round.

 If you've already filled out an ESP profile before, check here and include the following:

 
 
 

Your Profile:

(You can skip this section if you've filled out a previous profile before)

Asterisk (*) indicates a required field.

    Small Business Liason
     
     
     
 
 
   * Zip:
 
 
 
 


Typical Client Type:

Automotive Products / Services
Chambers of Commerce
Congregations
Financial Services
General Office
Grocery Store
Health Care
Home-Based Business / Home Office
Laboratory
Legal Services
Lodging
Manufacturing 		Nonprofit
Printer
Real Estate / Property Management
Restaurant / Food Service
Retail
Retail - Food
School
Services - Business
Services - Personal
Small Business Development Centers
Other

Products and Services

Types of products you provide:

Air conditioners
Air filters/cleaners
Ballasts
Boilers
Burners
Computers
Controls
Copiers
Daylighting
Doors
Dryers
Ducts 		Exhaust Systems
Exit signs
Fans
Fax machines
Freezers
Generators
Heaters
Humidifiers/dehumidifiers
Insulation
Lamps
Light fixtures
Meters 		Motors
Printers
Reflectors
Refrigerators
Roof Coating
Roofing
Sensors
Skylights
Software
Transformers
Washers
Other

Financial Services:
Energy Efficiency Improvement Financing
Equipment Financing/Leasing
Performance contracting/guaranteed savings
Start Up Assistance
Utilities Incentives/Financing

Other Services:
Auditing/survey/analysis
Construction design/specifications
Controls/tuning
Hazardous material handling
Indoor air quality
Lighting installation
Maintenance
Measurement/verification
Other equipment installation
Performance contracting
Project management/general contractor
Removal/recycling/disposal
Trial installations

Areas You Service:

All
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho

 Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana 		Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island 		South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands (US)
Virginia
Washington
West Virginia
Wisconsin
Wyoming

Please answer the following questions:

1. How have costs been reduced through energy efficiency? You may include what changes you made, why you decided to make changes, how long they took, and how the changes were financed.

2. Other than cost savings, how has the business benefited from the upgrades? For example, has the business experienced utility savings, improved productivity, increased sales, or local media coverage?

3. Please tell us about any obstacles or successes along the way.

4. Any lessons learned? What recommendations would you make to other small businesses?


Stage One: Lighting
Compact Fluorescent Lamps
T-8 Fluorescent
High-Pressure Sodium or Metal Halide
      Lighting
Occupancy Sensors
Other Controls
LED Exit Sign
Other

 

Stage Two: Building Tune-Up
Set Up Scheduled Maintenance
Heating/Cooling System Tune-Up
New Controls or Energy Management Systems
Hot Water Tank and Pipe Insulation
Solar Hot Water
Reduce Hot Water Settings
Other

     

Stage Three: Load Restriction
Improved Insulation
Leakage Reduction
New Windows
Window Film/Solar Screens
Planted Trees/Vines for Shade
Other

 

Stage Four: Heating and Cooling Distribution System
High-Efficiency Fan and Pump Motors
Variable-Speed Drives
Other

     

Stage Five: Heating and Cooling Plant
New-High Efficiency Air Conditioning System
New-High Efficiency Heating System
Solar Heating
Other

   

Annual Savings
  actual or estimated
  kWh or dollars
  therms or dollars
  gallons or dollars
  gallons or dollars
  lbs or dollars
  lbs or dollars

Customer's Profile:

     
   
      Rent
Own
     
 
 
   *
 
 
 
 

* What is the customer's type of business/organization?
(Tell us what they do in 10 words or less)

*(Please indicate how you would like to submit this form)
Submit as Success Story
Submit as Awards Application
Submit as both