Energy Efficiency Kit Order Acknowledgment Form

Home Efficiency Program Customer Application

It only takes about 3 minutes to complete this important step towards lower energy bills.

By submitting this application, you are applying to receive an Instant Savers Assessment through the Ameren Illinois Home Efficiency Program. Following your submission, a Program representative will contact you with more details.

If you have any questions, please call us at 1.866.838.6918.

Please verify that you meet the basic eligibility requirements of the Program:

Live in a single family home (A single family home is a free-standing residential building. Single family homes are designed to be used as a single-dwelling house or duplex.) *

Is this a Mobile Home?

Must be a residential customer of Ameren Illinois, heating with gas or electricity delivered by Ameren Illinois *

Maximum Gross Annual Household Income is at or below the amount listed on the Income Qualifications Chart at AmerenIllinoisSavings.com/AMIMap? *

If you are living in an apartment or condo, please follow the link and nominate your building for a FREE Energy Assessment AmerenIllinoisSavings.com/NominateYour Building.

If you own or rent a house, please complete the following application:

Account Number (If you are unable to locate or access your Ameren Illinois account number, please reach out to our customer care center for assistance: 1.800.755.5000) *

Format: ########## (no dashes)

Customer First Name *

Customer Last Name *

Address *

City *

Zip Code *

Customer Email Address *

Cell Phone *

Format: 000-000-0000

Home Phone

Format: 000-000-0000

How did you hear about us/Were you referred by? *

Provide the Program Ally's name if referred by a Program Ally *

Do you own your home? *

Yes

Primary Heat Source *

Gas

Electric

Propane

Type of foundation in your home, Check all that apply *

Basement

Crawl Space

Slab

Number of Members in Home, including yourself *

Number of Adults *

Number of Children *

List Full Names of Adults *

List Full Names of Children *

Currently live in your home, check all that apply *

By checking this box, I confirm that all information listed above is true and accurate and completing this application does not guarantee my household will receive incentives. Ameren Illinois may change the Program requirements, incentives, or terms and conditions at any time. The Program can send your contact information to Program Allies related to your project. *

Ameren Illinois Privacy Policy