Professional Application

Required Field *

Company Information

Business Name as shown on Income Tax Return (W-9) *

EIN

Federal Tax Classification --None-- LLC C LLC S LLC P LLC Single Member C Corporation S Corporation Partnership Other

Specify manufacturer(s), if you are a dealer

Business Sector --None-- Architect Broker Auditor/Inspector Contractor Contractor/Engineer Engineer Facility/Property Manager Manufacturer Owner/Owner Association Project Developer REIT Other Professional

Specify specific business(es), if applicable

State County License Number *

Enter N/A if Licensure is not required for your business

License Expiration Date

 

License Holder

License Type

Address as shown on income tax return (w-9) *

City *

State * --None-- Alaska (AK) Alabama (AL) Arkansas (AR) American Samoa (AS) Arizona (AZ) California (CA) Colorado (CO) Connecticut (CT) District of Columbia (DC) Delaware (DE) Florida (FL) Federated States of Micronesia (FM) Georgia (GA) Guam (GU) Hawaii (HI) Iowa (IA) Idaho (ID) Illinois (IL) Indiana (IN) Kansas (KS) Kentucky (KY) Louisiana (LA) Massachusetts (MA) Maryland (MD) Maine (ME) Marshall Islands (MH) Michigan (MI) Minnesota (MN) Missouri (MO) Northern Mariana Islands (MP) Mississippi (MS) Montana (MT) North Carolina (NC) North Dakota (ND) Nebraska (NE) New Hampshire (NH) New Jersey (NJ) New Mexico (NM) Not in USA (NS) Nevada (NV) New York (NY) Ohio (OH) Oklahoma (OK) Oregon (OR) Pennsylvania (PA) Puerto Rico (PR) Palau (PW) Rhode Island (RI) South Carolina (SC) South Dakota (SD) Tennessee (TN) Texas (TX) Utah (UT) Virginia (VA) Virgin Islands (VI) Vermont (VT) Washington (WA) Wisconsin (WI) West Virginia (WV) Wyoming (WY)

Postal Code *

Office Phone *

Mobile Phone

Fax Number

Email Address *

Website

Contact Information

Main Contact

First Name *

Last Name *

Contact Address is the same as the company address.

Street Address Line 1 *

Street Address Line 2

City *

State * --None-- Alaska (AK) Alabama (AL) Arkansas (AR) American Samoa (AS) Arizona (AZ) California (CA) Colorado (CO) Connecticut (CT) District of Columbia (DC) Delaware (DE) Florida (FL) Federated States of Micronesia (FM) Georgia (GA) Guam (GU) Hawaii (HI) Iowa (IA) Idaho (ID) Illinois (IL) Indiana (IN) Kansas (KS) Kentucky (KY) Louisiana (LA) Massachusetts (MA) Maryland (MD) Maine (ME) Marshall Islands (MH) Michigan (MI) Minnesota (MN) Missouri (MO) Northern Mariana Islands (MP) Mississippi (MS) Montana (MT) North Carolina (NC) North Dakota (ND) Nebraska (NE) New Hampshire (NH) New Jersey (NJ) New Mexico (NM) Not in USA (NS) Nevada (NV) New York (NY) Ohio (OH) Oklahoma (OK) Oregon (OR) Pennsylvania (PA) Puerto Rico (PR) Palau (PW) Rhode Island (RI) South Carolina (SC) South Dakota (SD) Tennessee (TN) Texas (TX) Utah (UT) Virginia (VA) Virgin Islands (VI) Vermont (VT) Washington (WA) Wisconsin (WI) West Virginia (WV) Wyoming (WY)

Postal Code *

County

Office Phone *

Mobile Phone

Fax Number

Email Address *

Other Contacts Please note if separate contact for Completion Certificates, Invoices or questions on Proposals (more contacts can be added once application is accepted)

Contact 2 Name

Contact 2 Phone

Comment

Contact 2 Email

Contact 3 Name

Contact 3 Phone

Comment

Contact 3 Email

Services

State * --None-- National Alaska (AK) Alabama (AL) Arkansas (AR) American Samoa (AS) Arizona (AZ) California (CA) Colorado (CO) Connecticut (CT) District of Columbia (DC) Delaware (DE) Florida (FL) Federated States of Micronesia (FM) Georgia (GA) Guam (GU) Hawaii (HI) Iowa (IA) Idaho (ID) Illinois (IL) Indiana (IN) Kansas (KS) Kentucky (KY) Louisiana (LA) Massachusetts (MA) Maryland (MD) Maine (ME) Marshall Islands (MH) Michigan (MI) Minnesota (MN) Missouri (MO) Northern Mariana Islands (MP) Mississippi (MS) Montana (MT) North Carolina (NC) North Dakota (ND) Nebraska (NE) New Hampshire (NH) New Jersey (NJ) New Mexico (NM) Not in USA (NS) Nevada (NV) New York (NY) Ohio (OH) Oklahoma (OK) Oregon (OR) Pennsylvania (PA) Puerto Rico (PR) Palau (PW) Rhode Island (RI) South Carolina (SC) South Dakota (SD) Tennessee (TN) Texas (TX) Utah (UT) Virginia (VA) Virgin Islands (VI) Vermont (VT) Washington (WA) Wisconsin (WI) West Virginia (WV) Wyoming (WY)

Property Classifications *

Commercial Only

Residential and Commercial

Residential Only

Primary Specialization * --None-- Building Envelope Cogeneration Elevator Emergency Standby Generator Equipment Geothermal Energy Green Roof HVAC Lighting Multimeasure Retrofit New Construction Other Other Resiliency PPA/ESA/EaaS Retroactive Finance Roof Seismic Construction Solar Energy Water Conservation Wind Energy Windows/Doors

Counterpointe Energy Solutions

Counterpointe Contact or Referred by

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