Better Buildings, Better Plants Voluntary Pledge Program

7/30/2015

Better Building Alliance

OMB Control No. 1910-5141
Exp. Date 6/30/2019
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BETTER BUILDINGS ALLIANCE SIGN­UP FORM
Please indicate the appropriate subgroup (Commercial Real Estate & Hospitality Sectors; Healthcare Sector; Higher Education Sector; Retail, Food
Service & Grocery Sectors).

Organization Name:
Primary Contact
First Name:

Last Name:

Title:

Email:

Address 1:

Address 2:

City:

State:

Zip:

Phone:

Select a State...

Alternate Contact
First Name:

Last Name:

Title:

Email:

Address 1:

Address 2:

City:

State:

Zip:

Phone:

Select a State...

Member Information
Select Subgroup:

Select Subgroup...

Building Portfolio
Number of buildings in your portfolio*:
*Include managed and franchised space, if applicable.

Total square footage of portfolio:
Percentage of portfolio that is third­party managed:
Percentage of portfolio that is franchised:

Energy Considerations
Do you track the energy use of your buildings via tools such as Portfolio Manager?

 Yes 
 No
What are your organization­wide energy­savings goals? [For example, portfolio­wide
savings of 10% over 2010 baseline; annual EUI improvement goals; Portfolio
Manager score targets] If you do not yet have organization­wide energy savings
targets, please explain any future plans to set such goals.

What are the primary challenges you currently face in meeting your goals?

Alliance members are encouraged to share strategies for success. Have you

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Better Building Alliance
overcome any efficiency barriers that you believe other Alliance members face? If
yes, please describe. If you have additional information/files you would like to send,
please attach and send in an email to [email protected].

Members are required to participate in at least one Solutions Team.
Please indicate your choice below.

 Market Solutions 
 Lighting & Electrical 
  Space Conditioning 
  Refrigeration 
  Plug & Process Loads 
  Energy Management Information Systems 
  Renewables Integration 
May we use your company logo on posters and other printed material for
reports and presentations?

 Yes
 No

If we have permission to use your logo, please provide contact information
for someone who can provide a high­resolution (300 dpi) version of logo.

 As an authorized representative of my organization, I agree to the Terms set forth above and request to join the Alliance.
Authorized Company Representative: 
Submit

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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 0.25 hour 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.

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