INSTRUCTIONS: Provide as much detail as possible, especially about the benefits received. Send attachments to firstname.lastname@example.org. Note that your submissions must be received by October 31, 2017. If you will be unable to make this cut-off date, call the National Lighting Bureau at 304/870-4249.
By entering your signature and date below, you are agreeing to the following statement: "To the best of my knowledge and belief, the information provided in this form and any attachments to it are true and factual."
If you have trouble submitting your form, please make sure your description of the system is under 999 characters. This can be checked by copying and pasting the text into a new Microsoft Word document, then clicking on "Tools", and "Word Count".
180 Reachcliff Drive
Shepherdstown, WV 25443
Phone: (304) 870-4249
The National Lighting Bureau is recognized by the U.S. Internal Revenue Service as a tax-exempt 501(c)(3) organization.