Energy Efficiency Fund

Fields preceded by an asterisk * are mandatory

To be eligible for financial assistance from the Energy Efficiency Fund (EEF), a request for financial assistance must be submitted before work begins. Please complete the following form to inform us about your project.

Applicant's identification

*	Contact name :		*	E-mail :
*	Applicant's email address (for receipt notification)

Customer identification

*	Name of company:
*	Contact person:		Title:
*	Telephone:	*	E-mail:

Technical firm (if different)

Name of company:
Contact person:		Title:
Telephone:		E-mail:

Information about the project

*	Gaz Métro Account No. for the building
*	Address:
*	Municipality:		* Postal code
*	Type of work proposed:	Replacing windows Insulating Making the building airtight Installing thermal screens in greenhouses
Other measures (specify)

IMPORTANT MESSAGE

This document must be submitted to the Energy Efficiency Fund before work begins. The start date of the work corresponds to the signature date on the contract outlining the project submitted for the request for financial assistance from the EEF.

* I have read and understand the above message.

Date : 04-02-2012

PC 420 – project outline form – v1
Last update: March 1^st, 2011