Rebate Product Form
Applicant Information
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Rebate Selection
Please select the Rebate you would like to apply for
Please select...
Recycled Refrigerator and/or Freezer
EnergyStar Clothes Dryer
Induction Cooktop (Measuring 30" or larger)
Smart Thermostat: Standard & Line-voltage (Quantity limits apply)
Whole House Fan (Not for powered attic ventilators)
Evaporative Cooler (Minimum 2,500 CFM)
Energy Star Heat Pump (Air Source) Water Heater
Additional Water Heater Incentives
Recycled Refrigerator and/or Freezer
Rebate Amount: $60
Appliance must be decommissioned for recycling and cannot be resold
Attach Receipt Here
How many appliances are you recycling?
Please select...
1
2
Connector Information - Recycled Refrigerator and/or Freezer
Record Type Name
Application Record Type ID
EnergyStar Clothes Dryer
Rebate Amount: $30 or $90 with Hybrid heat pump dryer
Hybrid heat pump dryer?
Please select...
Yes
No
Manufacturer
Model #
Attach Receipt Here
Rebate Amount
Connector Information - EnergyStar Clothes Dryer
Application Record Type ID
Record Type Name
Induction Cooktop
(
Measuring 30" or larger)
Rebate
$100 for Electric-to-induction Replacements
$350 per unit for gas-to-induction replacement or new construction (must include picture of gas stove)
Manufacturer
Model #
Attach Receipt Here
Connector Information - Induction Cooktop
(
Measuring 30" or larger)
Record Type Name
Application Record Type ID
Smart Thermostat: Standard & Line-voltage
(Quantity limits apply)
Rebate Amount: $25 per thermostat. Must be EnergyStar certified.
Smart Thermostat Type
Please select...
Standard
Line Voltage
Standard Quantity
Please select...
1
2
Line Voltage Quantity
Please select...
1
2
3
4
5
Manufacturer
Model #
Attach Receipt Here
Connector Information - Smart Thermostat: Standard & Line-voltage
(Quantity limits apply)
Record Type Name
Application Record Type ID
Whole House Fan
(Not for powered attic ventilators)
Rebate Amount: $100
Quantity
Please select...
1
2
Manufacturer
Model #
New Installation or Replacement?
Please select...
New Installation
Replacement
Primary or Secondary Cooling?
Please select...
Primary
Secondary
Attach Receipt Here
Connector Information - Whole House Fan
(Not for powered attic ventilators)
Record Type Name
Application Record Type ID
Evaporator Cooler (
Minimum 2,500 CFM)
Rebate Amount: $200
Quantity
Please select...
1
2
Manufacturer
Model #
Attach Receipt Here
Connector Information - Evaporator Cooler (
Minimum 2,500 CFM)
Record Type Name
Application Record Type ID
EnergyStar Heat Pump Water Heater
Rebate Amount: $350
Product Manufacturer
Product Model Number
Number of Gallons
Connector Information - EnergyStar Heat Pump Water Heater
Record Type Name
Application Record Type ID
Additional Water Heater Incentives
Incentives
Fuel Switching from Gas/Propane - $50
New Construction - $30
Manufacturer
Model #
Number of gallons
Attach Receipt Here
Connector Information - Additional Water Heater Incentives
Record Type Name
Application Record Type ID
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