Better Buildings, Better Plants Voluntary Pledge Program

OMB Control No. 1910-5141

Exp. Date XX/XX/XXXX

Background: DOE will highlight Better Buildings Challenge Financial Allies with profile pages on the program website. Please complete the information below.

1. Organization name.

How would you like your organization to be referenced?

Click here to enter text.

2. Background

Provide 2-3 sentences of background information on your organization. Suggested maximum of 100 words.

Click here to enter text.

3. Financial Commitment

Provide the total dollar value of your financial commitment.

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4. Target Market/ Description of Customers

Financing Structures: (Check applicable boxes)

☐ Energy Services Contracts

☐ Leases

☐ Performance Insurance

☐ Non-debt Structures

Types of Upgrades: (Check applicable boxes)

☐ Comprehensive Building Performance

☐ On-site Boiler Conversions

☐ Combined Heat & Power Conversions

☐ On-site Power Generation

☐ Payment Determined by Performance

What are the target markets or the specific customer group(s) that your financial product are designed to serve?

Occupancy Type: (Check applicable boxes)

☐ Owner-occupied ☐ Tenant-occupied

Building Types: (Check applicable boxes)

☐ Commercial Office ☐ University

☐ Retail ☐ Industrial

☐ Healthcare ☐ Food Service

5. Contact

Provide the name, title, telephone and email information for the person to contact at your organization in order to receive additional information about available products. This information will be published on the U.S. DOE BBC website.

• Name: Click here to enter text.

• Title: Click here to enter text.

• Telephone Number: Click here to enter text.

• Email Address: Click here to enter text.

5. Logo

Provide your organization’s logo as an attachment for place on your profile page.

File type options: high resolution .eps, ai or .jpg

6. Photo

Provide up to three photos of your owned or leased buildings as attachments for placement on your profile page. Please include captions and attributions, if applicable, below.

File type options: high resolution .jpd or .tiff

Click here to enter text.

This data is being collected to support the Department of Energy Better Buildings Initiative. The data you supply will be used for developing best practices to facilitate reductions in energy intensity by commercial, manufacturing, and community organizations.

Public reporting burden for this collection of information is estimated to average 0.5 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Office of the Chief Information Officer, Enterprise Policy Development & Implementation Office, IM-22, Paperwork Reduction Project (1910-5141), U.S. Department of Energy, 1000 Independence Ave SW, Washington, DC, 20585-1290; and to the Office of Management and Budget (OMB), OIRA, Paperwork Reduction Project (1910-5141), Washington, DC 20503.

Notwithstanding any other provision of the law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB control number.

Submission of this data is voluntary.

Learn more at energy.gov/betterbuildingschallenge