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<form id="LadwpcustomerAddForm" method="post" action="/">
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  <fieldset>
    <legend></legend>
    <div class="input text required">
      <p class="style12">Account Holder&nbsp;</p><label for="LadwpcustomerFirstName">
        <p class="style11" style="margin-top: 0; margin-bottom: 0;">First Name</p>
      </label><input name="data[Ladwpcustomer][first_name]" type="text" maxlength="25" value="" id="LadwpcustomerFirstName">
    </div>
    <div class="input text required"><label for="LadwpcustomerLastName">
        <p class="style11" style="margin-top: 0; margin-bottom: 0;">Last Name</p>
      </label><input name="data[Ladwpcustomer][last_name]" type="text" maxlength="25" value="" id="LadwpcustomerLastName"></div>
    <div class="input text">
      <p class="style11"></p><label for="LadwpcustomerAccountNumber">
        <p class="style12" style="margin-top: 0; margin-bottom: 0;">Account Number</p>
      </label><input name="data[Ladwpcustomer][account_number]" type="text" maxlength="15" value="" id="LadwpcustomerAccountNumber">
      <p class="style11">LADWP 10 digit account number, without spaces.</p>
    </div>
    <div class="input text required">
      <p class="style12">Service Address&nbsp;</p><label for="LadwpcustomerStreetAddress">
        <p class="style11" style="margin-top: 0; margin-bottom: 0;">Street Address</p>
      </label><input name="data[Ladwpcustomer][street_address]" type="text" maxlength="50" value="" id="LadwpcustomerStreetAddress">
    </div>
    <div class="input text"><label for="LadwpcustomerAptSuiteUnit">
        <p class="style11" style="margin-top: 0; margin-bottom: 0;">Apt Suite Unit</p>
      </label><input name="data[Ladwpcustomer][apt_suite_unit]" type="text" maxlength="25" value="" id="LadwpcustomerAptSuiteUnit"></div>
    <div class="input text required"><label for="LadwpcustomerCity">
        <p class="style11" style="margin-top: 0; margin-bottom: 0;">City</p>
      </label><input name="data[Ladwpcustomer][city]" type="text" maxlength="25" value="" id="LadwpcustomerCity"></div>
    <div class="input select required"><label for="LadwpcustomerState">
        <p class="style11" style="margin-top: 0; margin-bottom: 0;">State</p>
      </label><select name="data[Ladwpcustomer][state]" id="LadwpcustomerState">
        <option value="CA">CA</option>
        <option value="AL">AL</option>
        <option value="AK">AK</option>
        <option value="AZ">AZ</option>
        <option value="AR">AR</option>
        <option value="CO">CO</option>
        <option value="CT">CT</option>
        <option value="DE">DE</option>
        <option value="DC">DC</option>
        <option value="FL">FL</option>
        <option value="GA">GA</option>
        <option value="HI">HI</option>
        <option value="ID">ID</option>
        <option value="IL">IL</option>
        <option value="IN">IN</option>
        <option value="IA">IA</option>
        <option value="KS">KS</option>
        <option value="KY">KY</option>
        <option value="LA">LA</option>
        <option value="ME">ME</option>
        <option value="MD">MD</option>
        <option value="MA">MA</option>
        <option value="MI">MI</option>
        <option value="MN">MN</option>
        <option value="MS">MS</option>
        <option value="MO">MO</option>
        <option value="MT">MT</option>
        <option value="NE">NE</option>
        <option value="NV">NV</option>
        <option value="NH">NH</option>
        <option value="NJ">NJ</option>
        <option value="NM">NM</option>
        <option value="NY">NY</option>
        <option value="NC">NC</option>
        <option value="ND">ND</option>
        <option value="OH">OH</option>
        <option value="OK">OK</option>
        <option value="OR">OR</option>
        <option value="PA">PA</option>
        <option value="RI">RI</option>
        <option value="SC">SC</option>
        <option value="SD">SD</option>
        <option value="TN">TN</option>
        <option value="TX">TX</option>
        <option value="UT">UT</option>
        <option value="VT">VT</option>
        <option value="VA">VA</option>
        <option value="WA">WA</option>
        <option value="WV">WV</option>
        <option value="WI">WI</option>
        <option value="WY">WY</option>
      </select></div>
    <div class="input text"><label for="LadwpcustomerZipCode">
        <p class="style11" style="margin-top: 0; margin-bottom: 0;">Zip Code (5 digit)</p>
      </label><input name="data[Ladwpcustomer][zip_code]" type="text" maxlength="5" value="" id="LadwpcustomerZipCode"></div>
    <div class="input text">
      <p class="style12">Contact Information&nbsp;</p><label for="LadwpcustomerPhoneNumber">
        <p class="style11" style="margin-top: 0; margin-bottom: 0;">Phone Number</p>
      </label><input name="data[Ladwpcustomer][phone_number]" type="text" maxlength="20" value="" id="LadwpcustomerPhoneNumber">
    </div>
    <div class="input text required"><label for="LadwpcustomerEmail">
        <p class="style11" style="margin-top: 0; margin-bottom: 0;">Email Address</p>
      </label><input name="data[Ladwpcustomer][email]" type="text" maxlength="50" value="" id="LadwpcustomerEmail">
      <p class="style11">Please enter a valid email address; If you do not have one or do not wish to provide one, please contact our Call Center at (833) 280-8100 to find a participating contractor.</p>
    </div>
    <div class="input select">
      <p class="style12">Property Type</p><label for="LadwpcustomerPropertyType">
        <p class="style11" style="margin-top: 0; margin-bottom: 0;"></p>
      </label><select name="data[Ladwpcustomer][property_type]" id="LadwpcustomerPropertyType">
        <option value="SF">Residential</option>
        <option value="MF">Multi-Residential</option>
        <option value="CO">Commercial</option>
      </select>
    </div>
    <div class="input select">
      <p class="style12">Do You Own or Rent the Property?</p><label for="LadwpcustomerOwnRent">
        <p class="style11" style="margin-top: 0; margin-bottom: 0;"></p>
      </label><select name="data[Ladwpcustomer][own_rent]" id="LadwpcustomerOwnRent">
        <option value="Own">Own</option>
        <option value="Rent">Rent</option>
      </select>
    </div>
    <div class="input checkbox">
      <p class="style12"></p><input type="hidden" name="data[Ladwpcustomer][owner_permission_certification]" id="LadwpcustomerOwnerPermissionCertification_" value="0"><input type="checkbox" name="data[Ladwpcustomer][owner_permission_certification]"
        value="1" id="LadwpcustomerOwnerPermissionCertification"><label for="LadwpcustomerOwnerPermissionCertification">
        <p class="style11" style="margin-top: 0; margin-bottom: 0;">I certify that I am the property owner or have received authorization from the property owner to participate in the AC Optimization Program.</p>
      </label>
    </div><input type="hidden" name="data[Ladwpcustomer][create_date]" value="" id="LadwpcustomerCreateDate"><input type="hidden" name="data[Ladwpcustomer][preferred_contact_time]" value="" id="LadwpcustomerPreferredContactTime"><input type="hidden"
      name="data[Ladwpcustomer][communication_opt_out]" value="0" id="LadwpcustomerCommunicationOptOut">
  </fieldset>
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    <tbody>
      <tr>
        <td align="center" valign="middle">
          <p valign="middle"></p>
          <div class="submit"><input type="image" src="https://www.proctoreng.com/img/FindAContractor.jpg"></div>
          <p></p>
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      </tr>
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  </table>
</form>

Text Content

>  LADWP AC Optimization Program
> 
> 
>  
> 
> PROGRAM ADVISORY: 
> 
> Thank you for your interest in the program. Due to the increased demand for AC
> technicians during the summer season, customers may experience delays in
> receiving program services. Please check with the selected contractor to
> receive the most up-to-date service availability for your particular area. 
> 
>  
> 
> The AC Optimization Program provides a no-cost central air conditioner tune-up
> and energy saving rebate opportunities to LADWP Customers. 
> 
>  
> 
> > LADWP wants to help qualifying Residential and Commercial customers stay
> > comfortable and use energy more efficiently.  Cooling represents the largest
> > summertime energy cost for most homeowners and businesses.  An efficient,
> > well maintained AC system uses less energy, keeps you more comfortable, and
> > extends the life of your system.
> > 
> >  
> > 
> > Taking energy efficiency to the next level, LADWP also offers rebates to
> > help customers replace their old, inefficient AC units with new ENERGY STAR
> > Rated High Efficiency AC systems.
> 
>  
> 
> How will a tune-up make your AC more efficient?
> 
>  
> 
> > A participating certified HVAC technician performs a CheckMe! diagnostic
> > evaluation of your system, to determine how well the system is working, and
> > what changes are needed to get your AC back in tip-top shape.  The tune-up
> > service includes:
> > 
> >  * Outdoor Coil Cleaning
> >  * Replacement or Cleaning of Standard Air Filter
> >  * Initial CheckMe! Diagnostic test
> >  * Indoor Airflow Adjustment if needed
> >  * Refrigerant Level Adjustment if needed*
> > 
> > A follow-up diagnostic is run to confirm your AC system is running
> > efficiently and ready to keep you cool during the warm LA summer.  The
> > diagnostic result will also show if your existing system qualifies for the
> > LADWP Early Replacement with ENERGY STAR rebate - see below for details.
> > 
> >  
> > 
> > Please note: The outdoor ambient air temperature must be 55 degrees or
> > higher for program services to be provided. Your appointment may need to be
> > rescheduled to a warmer day.
> > 
> >  
> > 
> > Program services are limited to AC systems that have R-22 or R-410a
> > refrigerant. Systems with other refrigerant types are not eligible for
> > program services.
> > 
> >  
> > 
> > (* Program provides up to two pounds of additional refrigerant)
> 
>  
> 
> And to save more energy, how about a free Smart Thermostat?
> 
>  
> 
> > That's right! LADWP is offering a smart, learning thermostat including
> > installation** at no cost to their Residential customers with compatible
> > systems.  The smart thermostat learns your schedule and the temperatures you
> > prefer, so that it can save you on energy costs when you're not around, yet
> > keep you comfortable while you're home.
> > 
> >  
> > 
> > **One (1) Smart thermostat per system, including installation, is offered
> > free of charge to program participants. Zoned systems only qualify for one
> > thermostat. Some AC systems may be incompatible with the brand of thermostat
> > offered in the program. Systems with an existing smart thermostat are not
> > eligible for the free thermostat. Systems where a free smart thermostat was
> > previously installed under the program will not be eligible for an
> > additional free thermostat when the system(s) become eligible for
> > participation again. Customers may elect to purchase additional thermostats
> > or the thermostat of their choice and be eligible to receive a $50 or $75
> > rebate.
> > 
> >  
> > 
> > Not interested in the smart thermostat?  LADWP is making another
> > energy-saving control upgrade available to you at no cost, the "Western
> > Cooling Control" (WCC).  Ideal for the warm, dry California climate, the WCC
> > runs your indoor fan a bit longer to take advantage of "left-over" cooling
> > available when the AC shuts off.  The WCC is a great option for those
> > customers with systems not compatible with the smart thermostat, and is also
> > available to Commercial customers. 
> > 
> >  
> 
> What Rebates are available to help LADWP customers save even more?
> 
>  
> 
> > Early Replacement with ENERGY STAR
> > 
> >  
> > 
> > Replace your qualifying existing HVAC system with an ENERGY STAR
> > High-Efficiency system, and receive up to a $1,200 rebate from LADWP!
> > 
> > 
> > 
> >  
> 
> > Electrification Upgrade with ENERGY STAR
> > 
> >  
> > 
> > Upgrade your qualifying existing Gas Furnace w/ Air Conditioning system to
> > an ENERGY STAR High-Efficiency Heat Pump system, and receive up to a $3,000
> > rebate from LADWP!
> > 
> > 
> > 
> >  
> > 
> > If your electric service needs improvement to take advantage of the
> > Electrification rebate, LADWP is offering up to a $1,000 electric panel
> > upgrade rebate.
> > 
> > 
> > 
> >  
> > 
> > How to earn Early Replacement or Electrification rebates:
> > 
> >  * Have your existing system qualified for Early Replacement or
> >    Electrification by a CheckMe! Certified Participating Contractor.
> >  * A participating CheckMe! HVAC contractor provides an estimate of the cost
> >    to replace your system with a qualifying ENERGY STAR system.
> >  * The customer completes a simple rebate application, and the contractor
> >    applies for an HVAC replacement permit from the LADBS.***
> >  * The existing system is removed and the new unit professionally installed.
> >  * A CheckMe! diagnostic test confirms the system is correctly installed.
> >  * When the replacement permit is closed out by LADBS, the rebate is
> >    provided to the customer by the HVAC contractor.
> >  * Additional rebates may be available through other state & local programs.
> >    Please ask your HVAC contractor for more information.
> > 
> > ***An HVAC replacement permit must be obtained by the HVAC Contractor from
> > the Los Angeles Department of Building and Safety (LADBS) prior to the
> > installation of a new system. The permit must be closed out ("Finaled") by
> > the LADBS before any rebate can be paid.
> 
> 
> 
>  
> 
> Who can participate?
> 
>  
> 
> > The AC Optimization Program is available to LADWP electric service
> > residential and commercial customers whose AC system(s) have not been
> > optimized through an LADWP program within the last 2 years. Services are
> > provided on a first-come, first served basis, while program funds are
> > available. The customer must have a central air conditioner / central heat
> > pump system of 10 tons or less. The system must be a minimum of 1 year in
> > age, and be operational at the time services are provided under the program.
> > The smart thermostat is available only to LADWP residential customers. 
> > Renters are eligible to participate, but must certify that they have the
> > property owners' permission to participate in the program.
> > 
> >  
> > 
> > Multi-Residential property tenants may not request program services
> > directly, but instead should bring the program to the attention of their
> > property manager. Property managers should contact the program Call Center
> > at (833) 280-8100 for additional participation and property eligibility
> > information.
> > 
> >  
> 
> Additional Program Requirements
> 
>  
> 
> > All program services must be provided by a CheckMe! Certified Participating
> > Contractor.  CheckMe! Contractors are specially trained and certified by
> > Proctor Engineering Group, who is implementing the AC Optimization Program
> > on behalf of LADWP.
> > 
> >  
> > 
> > If your local contractor would like to participate, please have them call
> > (833) 280-8100 or e-mail Contractor Services at Proctor Engineering Group.
> > 
> > >  
> 
>  
> 
> Please provide the information below, then click on "Find a Contractor".
> 
>  
> 
> 
> 
> Account Holder 
> 
> First Name
> 
> Last Name
> 
> Account Number
> 
> LADWP 10 digit account number, without spaces.
> 
> Service Address 
> 
> Street Address
> 
> Apt Suite Unit
> 
> City
> 
> State
> 
> CA AL AK AZ AR CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO
> MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
> 
> Zip Code (5 digit)
> 
> Contact Information 
> 
> Phone Number
> 
> Email Address
> 
> Please enter a valid email address; If you do not have one or do not wish to
> provide one, please contact our Call Center at (833) 280-8100 to find a
> participating contractor.
> 
> Property Type
> 
> 
> 
> Residential Multi-Residential Commercial
> 
> Do You Own or Rent the Property?
> 
> 
> 
> Own Rent
> 
> I certify that I am the property owner or have received authorization from the
> property owner to participate in the AC Optimization Program.