Rebate Form

Smart Thermostat Rebate

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Next Steps: Install the User Registration Add-On

This form requires the Gravity Forms User Registration Add-On. Important: Delete this tip before you publish the form.

CUSTOMER INFORMATION

Name(Required)
Address (Where Unit Is Installed)(Required)
Address (Where Unit Is Installed)(Required)
Mailing Address (If Different Than Above)
Mailing Address (If Different Than Above)
Email address
Electric Utility Account Number(Required)
Manufacturer

RESIDENTIAL INFORMATION

Check One
Check One
Is This A Rental Property?
Did the rebate influence your purchase?
Primary fuel to heat your home:
Primary method to cool your home:
How did you hear about this rebate?

THERMOSTAT INFORMATION

Model
Cooling Tons Controlled
SEER Rating of Cooling Unit
This field is for validation purposes and should be left unchanged.