EmPower Intake Form

EmPower New York is a program sponsored by the New York State Energy Research and Development Authority (NYSERDA), which provides assistance to income-eligible customers to help make their homes more energy efficient.

This form is not an application. Fill out this form if you would like to receive a EmPower NY application from Orange & Rockland. Please note that it may take up to six weeks to receive an application.

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ALL FIELDS ARE REQUIRED, UNLESS OTHERWISE NOTED

First and Last Name

Address

Phone Number

Account Number

I certify that I am financially responsible for the account listed above. I hereby authorize Orange & Rockland Utilities, Inc. to provide my historical energy consumption information, including account number(s), related to the above property address, to the New York State Energy Research and Development Authority (NYSERDA) and/or its designated representatives, for the period beginning two years prior to the application date and ending three years after participation in the EmPower New York program. I additionally authorize release of my contact information and income documentation to NYSERDA and/or its designated representatives for the purpose of determining my eligibility for EmPower New York. I understand that the information will be kept confidential to the full extent of the law and used only for the purposes of determining eligibility for NYSERDA programs and financial incentives and evaluating energy savings.

I agree

Required Field