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Installation Address City State Email Daytime Phone Energy Factor EF Unit Size - Gallons 55 max Zip Cleco Account Purchaser s name Purchaser s address if different than installation address Manufacturer Model Home Heating Fuel Type check one Natural Gas Electric Heat Pump Gas Boiler Is electric cooling present circle one Yes No By signing below purchaser authorizes Cleco to perform a phone survey or physical inspection to confirm installation. Rebate checks will be paid to Cleco account...
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