Customer Rebate Application

Customer Rebate Application
Name*

First NameLast Name
Email *
example@example.com
Phone Number*
Please enter a valid phone number.
Benton PUD Account #*
Account # can be located on your Benton PUD bill
Service Location Address*

Street Address

Apartment

CityState

Zip Code
My Mailing Address is the same as the Property Address

Yes
Mailing Address*

Street Address

Apartment

CityState

Zip Code
Rebate Program(s) - Select All That Apply

Clothes WasherClothes DryerHeat Pump Water HeaterSmart ThermostatCommunicating Line Voltage ThermostatElectric Vehicle (EV)Level 2 EV ChargersEnergy Efficient Manufactured Home (NEEM)

Clothes Washer
Clothes Washer
Manufacturer*
Model Number*
ENERGY STAR® Qualified?*

YesNo
Please upload a digital copy of your receipt*

Receipt should include your name, address, purchase date, appliance make and model
Cancelof

Clothes Dryer
Clothes Dryer
Manufacturer*
Model Number*
ENERGY STAR®Qualified?*

YesNo
Please upload a digital copy of your receipt*

Receipt should include your name, address, purchase date, appliance make and model
Cancelof

Heat Pump Water Heater
Heat Pump Water Heater
Space Type*
Heat Pump Water Heater Type*
Please upload a digital copy of your completed Manufacturer Checklist*

Cancelof
Please attach a copy of your customer invoice. To qualify, the invoice must include your name, address, the make, model, and purchase date*

To qualify, invoice must include your name, address, make, model, and purchase date
Cancelof
Please attach a copy of your signed Heat Pump Water Heater form that can be found below*

Cancelof
The Heat Pump Water Heater Installation Form and a list of qualifying heat pump water heaters can be found on our Residential Rebates page under details for the Heat Pump Water Heater Rebate Programs.

Smart Thermostat
Smart Thermostat
Heating System Type*
Please upload a digital copy of your receipt *

Receipt should include your name, address, purchase date, appliance make and model
Cancelof
Please attach your signed Smart Thermostat Project Information Form*

Cancelof
The Smart Thermostat Project Information Form and a list of qualifying thermostats can be found on our Residential Rebates page under details for the Smart Thermostat Rebate Program.

Communicating Line Voltage Thermostat
Communicating Line Voltage Thermostat
Heating System Type*
Please upload a digital copy of your receipt *

Receipt should include your name, address, purchase date, appliance make and model
Cancelof
Please attach your signed Communicating Line Voltage Thermostat Project Information Form*

Cancelof
The Communicating Line Voltage Thermostat Form can be found on our Residential Rebates page under details for the Communicating Line Voltage Thermostat Rebate Program.

Level 2 EV Chargers
Level 2 EV Chargers
Please attach a digital copy of your receipt*

Cancelof
Please attach a digital copy of your Proof of Energy Star Rating*

Cancelof
Please attach a digital copy of your Level 2 EV Charger Project Information Form*

Cancelof
The Level 2 Charger Form can be found on our Residential Rebates page under details for the Level 2 EV Charger Rebate Program.

Energy Efficient Manufactured Home

NEEM/ENERGY STAR® Certified
Energy Efficient Manufactured Home
Home Manufacturer*
Year Built*
Square Feet*
Heating System Type*
Energy Efficient Label ID #*
Please attach a copy of the Certificate of Compliance from the Manufacturer *

Cancelof

Rebate Acknowledgement

By entering my first and last name below, which constitutes a legal signature, I certify that all information listed in this rebate application is true and correct and that my address is in the Benton PUD service territory. I understand that completion of this rebate application does not guarantee me a rebate. I acknowledge that Benton PUD's Rebate Program is subject to change at any time.
Rebate Acknowledgement
Name*

First NameLast Name
Please verify that you are human*
Should be Empty:

Clothes Washer