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2. 
3. Smart Thermostat Rebate

   Please complete this form, and sign and date it.  All information is required to process the rebate(s). 

4. Date
   Date
6. Utility Account Number:
8. First Name*
9. Last Name*
11. Installation Address*
13. City*
14. State*
15. Zip Code*
17. Email Address*
18. Phone Number*
20. Mailing Address (if different):
22. City
23. State
24. Zip Code
26. Existing Equipment Information

    One Smart Thermostat per furnace or heat pump controlled, with a limit of two per household. 

27. What heating system is the thermostat controlling?
    -- Select One --Electric Forced Air FurnaceHeat Pump

    Thermostat 1

28. What heating system is the thermostat controlling?
    -- Select One --Electric Forced Air FurnaceHeat Pump

    Thermostat 2

30. New Equipment Information
32. Manufacturer*
    -- Select One --EcobeeGoogle NestLennoxResideo Technologies (Honeywell Home and First Alert)

    Thermostat 1

33. Model Name*
    -- Select One --Ecobee 3Ecobee 4Ecobee 5 Smart Thermostat with Voice ControlEcobee 6 Smart Thermostat PremiumSmart Thermostat EnhancedGoogle Nest Learning ThermostatGoogle Nest Thermostat ENest ThermostatiComfort M30 Smart ThermostatT9 Smart ThermostatT10 Pro Smart ThermostatX7S SeriesX8S SeriesElitePRO S1000 (all models)ElitePRO S1100 (all models)ElitePRO S1200 (all models)
34. Thermostat Serial Number
36. Upload Invoice or Receipt*
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit Submit and Print

* indicates a required field