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Weatherization Assistance Program (WAP) Landlord Authorization & Consent Form

Owner Information

Owner’s Full Name

Owner Phone Number

Owner Email Address

Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Property Information

Property Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Do you agree to allow ECA to provide energy conservation and weatherization services to your property?(Required)

I Agree

I Do Not Agree

Tenant’s Full Name

Monthly Rent Amount ($)

Upload Current Lease(Required)

Accepted file types: pdf, jpg, png, Max. file size: 256 MB.

ECA Weatherization Terms and Agreements

Agreement Certification(Required)

I agree to all terms and conditions listed below

By checking this box, I acknowledge and agree to the following: 1. I certify that I own the property or have authority to act on behalf of the owner. 2. ECA and/or its contractors may enter the property to inspect and perform weatherization services, including follow-up visits and inspections. 3. I will not evict the tenant for 24 months as long as lease obligations are met. 4. I will not increase rent due to weatherization improvements for 24 months. 5. Rent may still increase for other valid reasons. 6. I acknowledge receipt of EPA “Basic Radon Facts” and understand tenant education will be provided. 7. I release and hold harmless ECA and its contractors from liability related to the property, except where caused by ECA.

Owner Signature

Entry Id

Weatherization Assistance Program (WAP) Landlord Authorization & Consent Form

Owner Information

Property Information

ECA Weatherization Terms and Agreements

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