City of Nelson Bike Loan Application

2. Introduction
   The Participant hereby applies to Nelson Hydro for a loan of up to $8,000 for the purpose of purchasing a bicycle(s) to be repaid through On-Bill Financing and subject to the Terms and Conditions.

   The Participant hereby applies to Nelson Hydro for a loan of up to $8,000 for the purpose of purchasing a bicycle(s) to be repaid through On-Bill Financing and subject to the Terms and Conditions.

4. Privacy Statement
   Use of Personal Information – Nelson Hydro is collecting your personal information in accordance with Section 26 of the Freedom of Information and Protection of Privacy Act. Nelson Hydro collects your information for the purpose of administering programs and services. If you have any questions, please contact the City of Nelson’s Privacy Head at 310 Ward Street, Nelson, BC V1L 4P1 or FOI@nelson.ca or 250-352-8234.

   Use of Personal Information – Nelson Hydro is collecting your personal information in accordance with Section 26 of the Freedom of Information and Protection of Privacy Act. Nelson Hydro collects your information for the purpose of administering programs and services. If you have any questions, please contact the City of Nelson’s Privacy Head at 310 Ward Street, Nelson, BC V1L 4P1 or FOI@nelson.ca or 250-352-8234.

6. SECTION A: PARTICIPANT INFORMATION

8. First Name*

9. Last Name*

11. Phone Number*

12. Email Address*

16. SECTION B: PROPERTY INFORMATION
    Participant must be the registered owner of the property.

    Participant must be the registered owner of the property.

18. Civic Address of Property*

19. Nelson Hydro Account Number for Property*

21. Are you subscribed to Pre-Authorized Withdrawals?
    If no, you can sign up for auto-withdrawal after approval. This is a mandatory requirement for both loan payment and electrical consumption.

    If no, you can sign up for auto-withdrawal after approval. This is a mandatory requirement for both loan payment and electrical consumption.

23. YES / NO*
    -- Select One --YesNo

27. SECTION C: LOAN REQUEST
    Please fill in the following:

    Please fill in the following:

29. Make, model and price of bike(s).*

31. Bike Vendor:*

32. Number of Bikes:*
    -- Select One --123456 +

34. Accessories (safety gear, plus items for commuting). *Clothing is not included.

36. Total Loan Amount Requested: $*

37. Amortization Period: *
    -- Select One --2 Year Term at 3.5% fixed.5 Year Term at 3.5% fixed.

    See Cost Estimator Below:

39. 

43. SECTION D: SURVEY INFORMATION

45. Do you currently own a vehicle?*
    -- Select One --YesNo

46. If you own a vehicle, what kind is?
    -- Select One --Electric VehicleHybridGas

48. How many vehicle kilometres do you expect to reduce per year?

50. How do you anticipate this program will change your vehicle use?*

54. LOAN AGREEMENT - TERMS & CONDITIONS
    *** PLEASE READ THE TERMS & CONDITIONS *** Upon approval, the EcoSave Coordinator will email you the Terms & Conditions to manually sign off. Questions? Please email ecosave@nelson.ca.

    *** PLEASE READ THE TERMS & CONDITIONS *** Upon approval, the EcoSave Coordinator will email you the Terms & Conditions to manually sign off. Questions? Please email ecosave@nelson.ca.

56. Terms & Conditions
    Click Here to read the Term & Conditions

58. ADMINISTRATIVE USE ONLY: DO NOT COMPLETE

60. Date: _______________________________________________

    Date: _______________________________________________

62. EcoSave Authorization ______________________

    EcoSave Authorization ______________________

63. Loan Agreement No. ______________________________

    Loan Agreement No. ______________________________

65. Currently on Automatic Withdrawal:

67. Date: __________________________________

    Date: __________________________________

68. Yes___________ No ___________

    Yes___________ No ___________

70. Nelson Hydro Billing Department Authorization: __________________________________________

    Nelson Hydro Billing Department Authorization: __________________________________________

72. Notes: ____________________________________________________________________________________

    Notes: ____________________________________________________________________________________

Leave This Blank:


74. 1. Receive an email copy of this form.
75. Email address

    This field is not part of the form submission.

76. Submit

* indicates a required field