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Energy Audit
                                                   Application Form
Application Deadline: August 10, 2012
City of Danville
Name of Business
Address
City                                                                    Zip
Phone Number                                                            Fax


                       Own or rent the facility      Own        Rent/Lease (must provide owner information)
               Normal, daily operating hours
   Total occupants during normal operations
              Total square feet of the facility
                Year facility was constructed
          Has building ever been renovated?
               If yes, year of last renovation
                        Fuel source used for:      Heating
                                                   Cooling

Contact Information
Contact Name                                                           Title
Contact Phone Number                                                   Contact Email

Owner Information
Owner Name                                                             Phone Number
Owner Address
City                                                                   Zip

Companies who wish to take advantage matching funds are required.
City of Danville is offering a low interest 5 year loan to be applied towards implmentation.


Report Delivery
Send Audit Report to:


I authorize Earthwell Energy Management, Inc. to conduct an Energy Audit of the organization listed on this form
and provide me with an energy savings analysis. I permit KU to provide Earthwell with all utility
information (usage and cost) for the past twelve months.

                          This is a service offered by City of Danville and you are not required
                                      to pay a separate fee to receive this service.
     Authorized Signature                                                       Date
     Print Name and Title

       To participate in City of Danville Energy Audit Program, complete, sign and fax this form to: 1-502-587-8272
                                          For assistance, please call 1-502-587-8447

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City of Danville Energy Audit Application

  • 1. Energy Audit Application Form Application Deadline: August 10, 2012 City of Danville Name of Business Address City Zip Phone Number Fax Own or rent the facility Own Rent/Lease (must provide owner information) Normal, daily operating hours Total occupants during normal operations Total square feet of the facility Year facility was constructed Has building ever been renovated? If yes, year of last renovation Fuel source used for: Heating Cooling Contact Information Contact Name Title Contact Phone Number Contact Email Owner Information Owner Name Phone Number Owner Address City Zip Companies who wish to take advantage matching funds are required. City of Danville is offering a low interest 5 year loan to be applied towards implmentation. Report Delivery Send Audit Report to: I authorize Earthwell Energy Management, Inc. to conduct an Energy Audit of the organization listed on this form and provide me with an energy savings analysis. I permit KU to provide Earthwell with all utility information (usage and cost) for the past twelve months. This is a service offered by City of Danville and you are not required to pay a separate fee to receive this service. Authorized Signature Date Print Name and Title To participate in City of Danville Energy Audit Program, complete, sign and fax this form to: 1-502-587-8272 For assistance, please call 1-502-587-8447