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.
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.
6. SECTION A: PARTICIPANT INFORMATION
8. First Name*
9. Last Name*
11. Phone Number*
12. Email Address*
16. SECTION B: PROPERTY INFORMATION

    Property must be residential and located within City of Nelson. 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.
23. YES / NO*
    -- Select One --YesNo
25. You can finance home energy upgrades on your Nelson Hydro bill and access maximum rebates and grants by combining Federal, Provincial and utility programs, and we help with every step. Are you interested in learning more?
27. YES / NO
    -- Select One --YesNo
31. SECTION C: LOAN REQUEST
    Please fill in the following:
33. Make, model and price of bike(s).*
35. Bike Vendor:*
36. Number of Bikes:*
    -- Select One --123456 +
38. Accessories (safety gear, plus items for commuting). *Clothing is not included.
40. Total Loan Amount Requested: $*
41. Amortization Period: *
    -- Select One --2 Year Term at 3.5% fixed.5 Year Term at 3.5% fixed.

    See Cost Estimator Below:
43. 
47. SECTION D: SURVEY INFORMATION
49. Do you currently own a vehicle?*
    -- Select One --YesNo
50. If you own a vehicle, what kind is?
    -- Select One --Electric VehicleHybridGas
52. How many vehicle kilometres do you expect to reduce per year?
54. How do you anticipate this program will change your vehicle use?*
56. How did you hear about the E-Bike Loan Program?
60. 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.
62. Terms & Conditions
    Click Here to read the Term & Conditions
64. ADMINISTRATIVE USE ONLY: DO NOT COMPLETE
66. Currently on Automatic Withdrawal:
68. Yes___________ No ___________
70. Nelson Hydro Billing Department Authorization: __________________________________________
72. 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