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Legal Name of Entity*

Property Address

Primary Contact Name*

Primary Contact Email*

Primary Contact Phone Number

Square Footage of Building

Instillation Type

Roof-Top

Ground-Mount

Carport

Annual Power Usage (Total KWh)

Have you been in business for 4 years?

Tax Structure

For-Profit

Non-Profit

Religious Institution

Municipality

NAICS CODE (6 digit code)

Did You Show A Profit On Last Years Taxes Or Foresee A Taxable Profit In The Future? (This Questions Pertains To The Benefits OF Federal ITC's and/or Other Incentives)

Funding Source

Loan

Cash

PPA or Lease

Property Ownership

Own

Lease

Comments and Questions*

Consultant who introduced you to us

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contactus@libertisolutions.com

Leading the way forward

717-298-0436

Liberti Solutions is the Financial Services and Environmental Stewardship arm of Liberty Medical a Limited Liability Company