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2. 
4. Name
5. Email Address
7. Address
9. City
10. State
11. Zip Code
13. Phone Number
14. Account #*
16. Installation Address (if different)
18. City
19. State
20. Zip Code
22. Door Information

    Rebate per door, $40 up to two doors per household. 

24. Energy Star Insulated Exterior Door*
    -- Select One --YesNo
25. Brand*
26. Model #*
28. Home type*
    -- Select One --Single FamilyManufactured
29. Number of doors installed*
    -- Select One --OneTwo
31. Note:

    Post-installation inspection, Energy Star labels, and receipts are required to qualify for door rebate(s).  Existing multi-family buildings and new construction do not qualify.  

33. Upload Invoice or Receipt*
35. Upon signing this agreement, customer acknowledges the following:

    Rebate offer(s) may be changed or discontinued at any time by Forest Grove Light & Power (FGL&P).  FGL&P disclaims any warranty, whether expressed or implied, regarding the product(s) listed above for any materials or labor associated with installation, maintenance, repair, or any energy savings associated with use.  Rebate offer(s) applies to new product(s) only.  FGL&P reserves the right to inspect installed product(s).  Product(s) must meet all program criteria to qualify for rebate(s).  I understand the above and certify that I am the customer of FGL&P, that the product(s) is/are installed and operating at the location indicated above and that this address is within the FGL&P service area. 

37. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
39. Electronic Signature*
40. Date*
    Date
Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit Submit and Print

* indicates a required field