Energy Efficiency Standards Act | Certification Form

Certification Form

 
Product type:

Manufacturer Information

 
Name:
Address:

Street Address

Address Line 2

City
State / Province / Region

Postal / Zip Code
Country
Point of contact name: *
Point of contact telephone:

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Point of contact fax:

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Point of contact email: *

Product Information

 
Product name:
Identification number:

Compliance Statement

 

I assert that the product identified on this certification conforms to the standards to the efficiency standards contained in the Energy Efficiency Standards Act, State Government Article, Section 9-2006(e) Annotated Code of Maryland.
Name *

First
Last
Title
Date Time *

MM 		/
DD 		/
YYYY

Testing Laboratory Information

 
Lab name:
Address:

Street Address

Address Line 2

City
State / Province / Region

Postal / Zip Code
Country
Web Site
Point of contact name:

First
Last
Phone

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Fax:

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Email
Test method:

Labeling Information

 
Brief discussion as to whether the product shall bear a Maryland label or if not what label it shall have that reflects that the products meets an efficiency standard equal to the one reflected in the Energy Efficiency Standards Act.

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