Energizing Spaces Appliance Application Form

Please Note: Ensure the quotes are for EnergyStar appliances. We will assume your quote is for EnergyStar. However, we will randomly check at the reimbursement stage to ensure EnergyStar appliances are purchased. We will not reimburse appliances that do not meet this requirement. 

2023 Energizing Spaces Appliance Application Form

This application is used to apply for used or new appliances. We want you to focus on the program or purpose for which the appliances will be utilized. Energizing Spaces is about having impact to tell us about the users and how they will benefit.

Organization's Address
Organization's Address
City
State/Province
Zip/Postal
Country
Mailing Address (if different from physical address)
Mailing Address (if different from physical address)
City
State/Province
Zip/Postal
Country