CLIIP Post-Inspection & Verification of Purchase Form

Applicant Information

Note: All fields below are required.

Unique application ID(*)

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Main customer name(*)

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Name on IRWD billing statement

Main customer street address(*)

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Zip code(*)

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Contact person

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First and last name

Contact email(*)

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Contact phone number(*)

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IRWD account number

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List all account numbers as applicable

Device Installation Information

Please check all components that were installed(*)

Attach invoice(s)(*)

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(*)

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Once application has been submitted, the customer will receive an email notification that an IRWD staff will contact to schedule post-installation verification.

Review Terms and Conditions.

customer care

customer care