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HVAC On-Bill Repayment (OBR) Pre-approval Request Form
* These fields are required
PSE&G Account Holder
PSE&G Account Holder Full Name*
Primary Street Address (Mailing Address) 1*
Primary Street Address (Mailing Address) 2
Primary City*
Primary State*
Primary ZIP*
PSE&G Account Holder: Phone Number (best contact phone)*
PSE&G Account Holder: Email Address
Utility Accounts
Please select which PSE&G account(s) the customer has and enter the utility account number(s).*
PSE&G Electric Service Utility Account #:
PSE&G Electric Service Utility Account #:
PSE&G Gas Service Utility Account #:
PSE&G Gas Service Utility Account #:
Electric or Gas Service Provider Name (if not PSEG)
Electric or Gas Service Provider Account Number
Installation Address
Click box if installation address is the same as primary address
Installation Address 1*
Installation Address 2
Installation City*
Installation State*
Installation ZIP*
Contractor Information
Contractor Name*
Contractor Email*
OBR Cost Information
Total Cost of Project*
$
Total On-Bill Repayment (OBR) amount requested (not to exceed $25,000)*
$
PSE&G Utility Account Number for Repayment*
Notes