HeatUpWisconsin Nomination Form

October 7th Installation

The Heat U.P. Wisconsin program aims to help people -- people in need as well as those who deserve a "thank you" for their service, whether in our military or within their community.

To nominate yourself or someone you know, simply complete the online form below, providing as much information as possible. Submissions are based on a variety of criteria, including physical, mental, or social disabilities; financial challenges; job loss; military service; community service; and more.

The furnace being provided is a ‘Forced Warm Air’, 93% AFUE unit either LP or Natural Gas. It is not compatible with ‘Mobile Homes / Manufactured Housing’. The furnace does require a complete ductwork system. Hydronic systems, boilers, wood stoves, outdoor wood boilers, electric baseboard heaters or fireplaces are not eligible to be replaced or added onto with this program.

Please submit only one nomination for each person or family. Multiple submissions for the same person or family do not increase that nominee's chances of being selected.

You may submit more than one nomination. If you know several people who might qualify for a free furnace through the Heat U.P. Wisconsin program, nominate all of them! Please complete one form per person or family.

In the event your nomination is not selected, please submit a form for them again next year if the need still exists! We continue to try to help as many people as possible.

All submissions are due by September 5th. Those received after that date will go into the following year.

Please provide the following information regarding the person or family you are nominating for this award

Person Making The Nomination

Your Name*

Your City, State & Zip code*

Your Telephone*

Your email address*


Individual or Family Being Nominated

Their Name*

Their Address*

Their City, State & Zip code*


Their Telephone*

Their Email (if known)


Tell Us Their Story

How Did You Hear About Us (check all that apply)

Radio Ad with Dave Lennox
Newspaper Ad
Radio Ad by Local Lennox Dealer
Lennox Dealer Leave-Behind Info
Local Flyer / Poster
Outdoor Billboard
Lennox Dealer Statement / Invoice
Friend or Neighbor Information
Truck Advertising
Veterans Information
Prior Recipient
Prior Nominator
Direct Mail
Other (please specify in box below)

If from a Lennox Dealer, please enter the Dealer name here:


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