Contractor Registration Form

Legal Company Name

Business/Trade Name(DBA)

Company Website

First name

Last name

Email

Phone

Title

Primary Business Activity

Company Address

GeneralContractor/HVAC Contractor License

Business License Number

Years in Business

Number of Employees

Your company is

Minority-Owned Business Enterprise (MBE)

Women-Owned Business Enterprise (WBE)

Veteran-Owned Business Enterprise (VBE)

Disability-Owned Business Enterprise (DOBE)

(LGBTQ)-Owned Business Enterprise

N/A

Area you serve(Counties)

Do you currently work with any other grant programs or nonprofit or government agencies?

Yes

No

About Your Company

What are your specialty

Electric Heat Pump Water Heater

Electric Air-source or Ground source Heat Pump for SpaceConditioning

Residential Induction Kitchen Equipment

Electric Heat Pump Clothes Dryer

Electrical Service Panel Upgrade

Electric Wiring

Other

List 3 Business References with their contacts and phone numbers

Company W9 Form

By checking the box, I agree that I've reviewed and accepted the Terms and Conditions and have reviewed the Program Guidelines.

I understand that as a registered installer at United Hub, my contact information will be provided to rebate applicants for potential project consideration. However, project selection and engagement are determined solely by the applicants, and registration does not guarantee work.

UNITED HUB

PSE/CCA Decarbonization Program
Contractor Registration Form

UNITED HUB

PSE/CCA Decarbonization Program Contractor Registration Form

PSE/CCA Decarbonization Program
Contractor Registration Form