Please enter the address where the fridge will be installed. Note: This application is for Lanai residents only.
Address Line 2
Please enter your mailing address (P.O. Box). Note: This application is for Lanai residents only.
Number of people living at this address
Number of Bedrooms
Number of Bathrooms
Average monthly electricity bill
What is your household's annual income?
Less than $25,000
$25,000 - $40,000
$41,000 - $55,000
More than $55,000
How many refrigerators do you own? Please list model, year and size.
Why do you want to participate in Hui Up?
Thank you for your application for Hui Up on Lanai. We have received your application, and a Blue Planet Foundation representative will contact you shortly. In the meantime, if you have any questions or changes, please contact us at firstname.lastname@example.org. Mahalo!
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