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Application for Credit <br />This application is to be completed by the applicant without the lender's assistance and is required to determine eligibility for financing. <br />Applicants should complete this form as "Applicant" or "Co-Applicant" as applicable. Co-Applicant information must also be provided when the <br />income or assets of a person other than the Applicant (including the Applicant's spouse) will be used as a basis for qualification and/or <br />repayment of the loan or grant being requested. <br />Center for Energy and Environment ("CEE") <br />Amount $ <br />A portion of the information requested in this credit application is classified as "private data on individuals" under Minnesota Statute 462A.065. <br />Use of the data is limited to that necessary for the administration and management of this program by CEE personnel, those under contract with <br />CEE that have a need to know this information, and other governmental agencies when authorized by state statute or federal law. <br />Section 1: Terms Requested <br />Term (No. of Months) <br />How did you learn about CEE? <br />Property Address (where work will be performed): <br />Section 2: Property Information <br />Street:City:Zip: <br />County:Name of Neighborhood (if Applicable): <br />Number of Dwelling Units: <br />1-unit 2-unit 3-unit 4-unit Other <br />Year Built: Month and Year Purchased: Purchase Price: $ <br />Describe the Improvements to be made: <br />Applicant Name (include Jr/Sr if applicable) <br />Section 3: Applicant Information <br />Social Security Number Date of Birth <br /># and Ages of Dependants <br />Separated <br />Unmarried (includes single, divorce, widowed) <br />Married <br />Home Phone <br />Work Phone <br />Mobile Phone <br />Email <br />Present Address (if different than property address) <br />Previous Address (if less than 2 years at current) <br />RentOwn How Long? <br />Co-Applicant Name (include Jr/Sr if applicable) <br />Social Security Number Date of Birth <br />Separated <br />Unmarried (includes single, divorce, widowed) <br />Married <br /># and Ages of Dependants (if different than Applicant) <br />Home Phone <br />Work Phone <br />Mobile Phone <br />Email <br />Present Address (if different than property address) <br />Previous Address (if less than 2 years at current) <br />RentOwn How Long? <br />CEE / CEE_Application / 9-18 <br />Gas Company Name: Electric Company Name: <br />1 of 5