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Application for Credit <br />Center for Energy and Environment ("CEE" <br />This applicenon is to be romplood by the applican without the leaders assistance and is required to determine climbility, fnanc <br />or fiing. <br />Applicants should complete this fort a"Applicant" or' Co-Jphcanl" as applicable. Co-Applicaut information must also ee provided when the <br />come or asuce of a person other than the Applicant (inclluding the Applicant's spousewill he used as a basis for qualification and/or <br />Apayment of the loan or grant beiag requested. <br />porton ofthe informunon requested an this credit application is classified as "psivatc dare on individuate" under Minnewta Statute 462A.065. <br />Use of the dare is limited to that neremary for the administration and mnnngement of this yyrgmm by CEE personnel, those under contract with <br />CEE that bave a need to know this information, and other governmental agencies when anthonaed by stem statute m federal law. <br />Section l: Terms Recluested <br />Amount $ Term (No. of Months) <br />How did you learn about CEE? <br />Section 2: Property Information <br />Property Address (where work will be performed): <br />Street: <br />City: Zip: <br />County: <br />Name of Neighborhood (if Applicable): <br />Norther of Dwelling Units: <br />O 1 -unit O 2 -unit D 3 -unit D 4 -unit D Other <br />Date of Birth <br />Year Built: <br />Month and Year Purchased: <br /># and Ages of Dependants <br />Purchase Price: $ <br />Describe the Improvements to be made: <br />Home Phone <br />Gas Company Name: <br />Work Phone <br />Electric Company Name: <br />Section 3: Applicant Information <br />Applicant Name (include Jr/Sr if applicable) <br />Co -Applicant Name (include Jr/Sr if applicable) <br />Social Security Number <br />Date of Birth <br />Social Security Number <br />Date of Birth <br />D Married D Separated <br />D Unmarried (includes single, divorce, widowed) <br />D Married D Separated <br />D Unmarried (includes single, divorce, widowed) <br /># and Ages of Dependants <br /># and Ages of Dependants (if different than Applicant) <br />Home Phone <br />Home Phone <br />Work Phone <br />Work Phone <br />Mobile Phone <br />Mobile Phone <br />Email <br />Email <br />Present Address (if different than property address) <br />Present Address (if different than property address) <br />Previous Address (if less than 2 years at current) <br />D Own D Rent How Long? <br />Previous Address (if less than 2 years at current) <br />D Own D Rent How Long? <br />I of 5 <br />on r cEE- Iiusu 11-11 <br />