Company Application

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Company Name:*
Local Branch Name
Branch Address:
Same as company headquarters

Street Address Address Line 2 City State ZIP Code
Branch Phone Number (Posted on NXT Level Designation List)*
Branch Point of Contact (Main contact for all NXT Level communication regarding the branch or company) :*
First Last
Job Title:*
Job Title Other
Point of Contact Email address:*

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The following questions pertain to your branch only.
State(s) in which this company/branch maintains an active Business License:
- OR
- State Business License Number:*
- Contractor’s License Number:
- Electrical Contractor’s License Number:
Business License: WA
- WA
- State Business License Number:*
- Contractor’s License Number:
- Electrical Contractor’s License Number:
Business License: ID
- ID
- State Business License Number:*
- Contractor’s License Number:
- Electrical Contractor’s License Number:
Business License: MT
- MT
- State Business License Number:*
- Contractor’s License Number:
- Electrical Contractor’s License Number:

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I attest that the company meets the following legal requirements:*
- Maintains valid insurance for commercial general liability not less than $1,000,000 per occurrence and annual aggregate of not less than $1,000,000
Maintains automobile insurance*
- Maintains automobile insurance for all drivers

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Please list all employees at this branch/location that are interested in NXT Level training. Qualifying candidates are employees with at least one year of experience (if they'd like to earn the individual designation) and are directly involved in the sales, design and installation of lighting retrofit projects. Each employee will receive a link to the Individual Application, which must be completed before they can enroll in the training. Depending on experience or credentials, some employees may qualify to bypass the training to receive the NXT Level 1 designation. They still need to submit the Individual Application. See participation criteria for details.
List all employees at this branch/location that are interested in NXT Level training
Employee First Employee Last Email Address Phone Number

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By enrolling in NXT Level, this company/branch pledges the following commitments:
- Our company is currently participating in local utility programs for all eligible projects and is dedicated to continue to do so.
- We are dedicated to selling and/or installing energy efficient lighting technology and ensuring industry best practices are always utilized.
- We agree to include controls in all locations and applications where practical.
- Our company places a high value on training employees and continuous improvement.
- We are dedicated to our employees’ completion of the NXT Level training and will provide leadership and support throughout the process.
- Our company is committed to conduct its business consistent with the ethical standards of the utility as it works toward the best interest of the customer. The company holds its subcontractors to the same level of integrity.
Terms agreed*
- I have read, understand, and agree to the program Terms and Conditions. I certify that the information provided on this application is true and accurate to the best of my knowledge. I understand that if the information I have submitted is determined to be incomplete or inaccurate, the application may be rejected.
- Company Point of Contact Signature*
  
  Company Point of Contact
- Date of signature*
  MM slash DD slash YYYY
  
  Date
Comments
This field is for validation purposes and should be left unchanged.

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Employee First	Employee Last	Email Address	Phone Number