TVA-17653 Manufactured Homes (Residential) Work Completion Form

energy right® Program Manufactured Homes (Residential) Work Completion Form

OMB No. 3316-0019 Expires: 3/31/2007

1.

TVA Distributor ID Number:

     

TVA Distributor’s Name:

     

2.

Work ID Number:

     

3.

Date:

     

(mm/dd/yyyy)

4.

VHPC ID Number (or Name)

     

5.

Customer’s Name:

     

Telephone Number:

(     )      

6.

Customer’s Address:

     

Street Address

     

City, State, Zip Code

7.

Structure:

Single Section

Multi-Section

8.

Dealer’s Name:

     

Dealer Number:

     

9.

Dealer’s Address:

     

Street Address

     

City, State, Zip Code

10.

Total Cooling Capacity:

     

(tons)

11.

HP Indoor Coil Model Number:

     

12.

HP Outdoor Unit Model Number:

     

13.

Total Square Footage of Home:

     

14.

Heat Pump Brand:

     

TVA 17653 (4-2004)