Contractor Circle member enrollment application

Company information

* Required field

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Please provide contact information for the titles provided (use title closest to your own)
Primary Contact+ Name Title Email Address Phone
Yes No President/Owner/CEO
Yes No Service Manager/Project Coordinator
Yes No Sales Manager
Yes No Lead Service Technician
Yes No Administrative/Rebate Processor
Yes No

+Primary contact is the person responsible for day-to-day interaction with energySMART and will be listed as the primary contact for energySMART communications.

Customer types served

Residential (Single family and small multi-family up to 4 units)
Multi-Family (Buildings with 5 or more units)
Small Commercial (Businesses using < 60,000 therms annually; e.g. Dry cleaners, Motels, Restaurants)
Large Commercial/Industrial (Facilities using ≥ 60,000 therms annually; e.g. Manufacturing plants, Universities, Hospitals)

Business market segments served

If you only serve residential or multifamily customers skip this section.

Segment Percentage of all your work performed in this segment
(column sum must equal 100%)
Percentage of the work supported by program rebates/applications
Commercial: e.g. Retail, Office, Grocery and wholesale %
Food Service and Hospitality: e.g. Restaurants, Hotels and motels %
Industrial and Manufacturing: e.g. Fabrication, Cleaning/chemical products, Petroleum products and food processing %
Education: e.g. K-12 and post-secondary education %
Healthcare and other related institutions %
%

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Employee licenses and accreditations (select all that apply)

NATE
EPA Lead-Safe Certification
NCI
RESNET HERS Rater+
HVAC Excellence
Duct Sealing Certification*
ASME Boiler & Pressure Vessel Certification
Plumbing License
CFC EPA 608 Technician Certification
Electrical License
BPI – Building Analyst*
Builder License
BPI – Envelope Professional*

*Required for air sealing and insulation rebates, verified by energySMART.
+Required for residential new construction, verified by energySMART.

Diverse supplier status

energySMART works with many contractors and suppliers. Nicor Gas is committed to developing relationships with and increasing opportunities for diverse suppliers that provide quality, competitive prices and services for all of our customers. If you qualify as a diverse supplier for one of the classifications listed below, please check the appropriate button. If you are not a diverse supplier, please skip this section.

Eligible, not Certified Eligible and Certified+ Not Applicable
Minority Business Enterprise (MBE)
Small Disadvantaged Business (SDB)
Women Business Enterprise (WBE)
Veteran Owned Business (VBE)
Ability One
HUB Zone
Historically Black Colleges and Universities (HBCU)
Disadvantaged Business Enterprise (DBE)
Economically Disadvantaged Women-Owned Small Business (ED-WOSB)
Women-Owned Small Business (WOSB)
Service Disabled Veteran (DVBE)
Alaskan Native
Disabled
SBA 8(a)

+Requires current certificate from issuing organization

Illinois service territory (counties/regions):

All Counties
Adams
Boone
Bureau
Carroll
Champaign
Cook – North of I-290
Cook – South of I-290
DeKalb
DeWitt
DuPage
Ford
Grundy
Hancock
Henderson
Henry
Iroquois
Jo Daviess
Kane
Kankakee
Kendall
Lake
LaSalle
Lee
Livingston
McHenry
McLean
Ogle
Pike
Stephenson
Tazewell
Vermillion
Will
Winnebago
Woodford


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Which products and/or services do you provide?

Residential (single family or small multi-family up to 4 units)*

Not applicable (Does not install residential equipment)
Air Sealing & Insulation+
Duct Sealing+
Boilers
Furnaces
Storage water heaters
New construction - builders
New construction – raters
Thermostats

Business & multi-family (large multi-family, 5+ units)*

Not applicable (Does not install business or multi-family equipment)
Boilers
Boiler controls
Boiler tune-ups
Commercial food service equipment (e.g. fryers, ovens, broilers)
Condensing unit heaters
Furnaces
Infrared heaters
Ozone laundry
Pipe insulation
Pool/spa covers
Steam traps
Storage Water heaters
Thermostats

Would you be interested in participating in the Emerging Technology offering which would include working with manufacturers and customers to install new technologies being considered for energySMART? Yes No

This application is subject to the Contractor Circle enrollment requirements, participation requirements and terms and conditions. The company has read and agrees to the requirements and terms and conditions, and certifies that the above information is true and correct. By checking the box to the left and typing my name on the signature line below, I agree that I have the authority to legally sign on behalf of my company and this will have the same force and effect as an original signature.

I wish to opt out of posting the above information to the nicorgastebates.com directory of trade allies. This directory allows Nicor Gas customers to locate my business and contact information; opting out means I will not be listed.

*Signature:
*Title:
*Date

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