See if yoU Qualify HomeownersComplete The Questionnaire & See if you Qualify Now Do you own or rent your home Yes No Name * First Name Last Name Email * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Is Someone In Your Home Enrolled in any of the below programs? (If you are enrolled in any of these programs your income automatically qualifies for the appliance rebate program) Medicaid Supplemental Security Income (SSI) SNAP National School Lunch Program – Free WIC Housing Improvement Program (WIP) What is the estimated annual income for your household? (include all household members) How is your home heated currently? Gas (Furnace or Boiler) Oil Gas (Furnace or Boiler) Electric Heat Pump I Dont' Know What is the square footage of your household (if you don’t know, give an estimate)? Less than 1,000 Square Feet 1,000 - 1,500 Square Feet 1,500 - 2,000 Square Feet 2,000 - 2,500 Square Feet Over 2,500 Square Feet Thank you!
