New Construction
Project Enrollment
December 2015
Project Enrollment
AEP Ohio Application Number
(Select One)
Application Type NCR ―__ __ ― __ __ __ __ __
OVERVIEW
Please complete this Project Enrollment prior to submitting the Customer Agreement or holding an early design meeting. Customers
can submit this Project Enrollment early in the design and construction process to maximize the savings potential. Submitting this
Project Enrollment does not obligate the customer to participate in the AEP Ohio New Construction program, nor does it obligate AEP
Ohio to commit or pay incentives to the customer.
CUSTOMER INFORMATION
BUSINESS NAME
NAME AS IT APPEARS ON UTILITY BILL
AEP OHIO ACCOUNT NUMBER AT PROJECT SITE
TAXPAYER ID (SSN/FEIN)
W-9 TAX STATUS (SELECT ONE)
(Select One)
CONTACT NAME
TITLE OF CONTACT
PHONE
EMAIL
MAILING ADDRESS
CITY
STATE
ZIP
OH
HOW DID YOU HEAR ABOUT THE PROGRAM?
AEP OHIO OUTREACH NAME
(Select One)
PROJECT INFORMATION
Project Name
(if applicable)
□ Check if mailing address and project site address are the same
PROJECT SITE ADDRESS
BUILDING TYPE (SELECT ONE)
SHIFT
STATE
ANNUAL OPERATING HOURS
BUILDING AREA (SQ. FT.)
OH
ZIP
(Select One)
Retail
CONSTRUCTION TYPE
DO THE AREA(S) INCLUDED IN THIS APPLICATION HAVE LIGHTING CONTROLS?
(Select One)
Expected Completion Date
CITY
(Select One)
DOES THE FACILITY HAVE A DATA CENTER?
(Select One)
Pursuing LEED certification?
□ Yes □ No
New Construction | Project Enrollment
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Project Enrollment (cont.)
PROJECT CONTACTS
ARCHITECTURAL CONTACT NAME
TITLE
PHONE
FAX #
COMPANY
EMAIL
MECHANICAL CONTACT NAME
TITLE
PHONE
FAX #
COMPANY
EMAIL
ELECTRICAL CONTACT NAME
TITLE
PHONE
FAX #
COMPANY
EMAIL
CONTRACTOR NAME (IF KNOWN)
TITLE
PHONE
FAX #
COMPANY
EMAIL
Who should we contact regarding application questions?
□ Owner
□ Contractor
□ Architectural contact □ Mechanical contact □ Electrical contact
Renovation Projects (if applicable)
PERCENTAGE OF BUILDING UNDER RENOVATION
BUILDING AGE (YEARS)
ASHRAE VERSION USED
(Select One)
BUILDING SYSTEMS UNDER RENOVATION (MUST INCLUDE HVAC AND LIGHTING)
Design Incentives
For whole building performance projects, the AEP Ohio account holder may designate a firm to receive design incentives for projects achieving
10%+ better efficiency than applicable code requirements. See whole building performance specifications for incentive rate information. AEP Ohio
encourages projects striving for deeper savings to consider holding an early design meeting focused on energy early in the design process.
Will this project seek early design assistance?
Is this a whole building performance project?
□ Yes □ No
□ Yes □ No
Will this project seek design incentives?
□ Yes □ No
PROJECT ENROLLMENT AGREEMENT
Digital Signature Instructions
4. In the “Sign Document” pop-up box, you can select to change the
1. Click in the signature box.
2. Follow the digital signature directions displayed
signature appearance from typed font to an imported graphic.
5. Follow directions to save signed application; signature and
in the “Add Digital ID” pop-up box.
verification information will appear in the signature box.
3. Establish a digital ID and password.
Project Enrollment Agreement
□
□
I meet all eligibility criteria for this program.
As an eligible customer, I verify the information is correct and request consideration for participation under this program.
Customer Signature
Date
Title
Company
New Construction | Project Enrollment
Print Name
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