Contractor Rebate Application
Contractor Name
*
Contractor Verification Number
*
Contractor Email
*
example@example.com
Customer Name
*
First Name
Last Name
Customer Property Address
*
Street Address
Apartment
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Building Type
*
Site Built
Manufactured
Multi-Family (greater than 4 dwellings)
Existing Heat Type
*
Heat Pump
Forced Air Furnace - with A/C
Zonal
Forced Air Furnace - no A/C
Other
Rebate Program Type
*
Standard Residential
Low-Income Residential
Rebate Items(s) - Select All That Apply
Heat Pump
Ductless Heat Pump
Packaged Terminal Heat Pump
Insulation
Exterior Door
Window
Prescriptive Air Seal
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Heat Pump
Heat Pump
Heat Pump Type
*
Non-Variable Speed
Variable Speed
Heat Pump Rebate Required Documents:
Load Calculations
Balance Point
Pictures of Existing Equipment
AHRI Certificate
Participation Agreement
Customer Invoice
Please upload the required documents:
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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Ductless Heat Pump
Ductless Heat Pump
Ductless Heat Pump Rebate Required Documents:
AHRI Certificate
Participation Agreement
Customer Invoice
Please upload the required documents:
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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Next
Packaged Terminal Heat Pump
Packaged Terminal Heat Pump
Packaged Terminal Heat Pump Rebate Required Documents:
AHRI Certificate
Participation Agreement
Customer Invoice
Please upload the required documents:
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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Insulation
Insulation
Insulation Type
Attic
Wall
Floor
Attic: SQFT
*
Attic: Starting R-Value
*
Attic: Ending R-Value
*
Wall: SQFT
*
Wall: Starting R-Value
*
Wall: Ending R-Value
*
Floor: SQFT
*
Floor: Starting R-Value
*
Floor: Ending R-Value
*
Insulation Required Documents:
*
Certificate
Warranty
Participation Agreement
Customer Invoice
Please upload the required documents:
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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Exterior Door
Exterior Door
Number of Doors
*
Door Required Documents:
*
Energy Star Documentation
Participation Agreement
Customer Invoice
Please upload the required documents:
*
Browse Files
Drag and drop files here
Choose a file
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of
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Window
Window
Existing Window Type
*
Single Pane
Double Pane Metal Frame
SQFT
*
Window Required Documents:
*
Window U-Value
Manufacture Warranty
Contractor Warranty
Participation Agreement
Customer Invoice
Please upload the required documents:
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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Prescriptive Air Seal
Prescriptive Air Seal
Prescriptive Air Seal Type
*
Ceiling
Floor
Ceiling SQFT
*
Floor SQFT
*
Air Seal Required Documents:
*
Participation Agreement
Customer Invoice
Please upload the required documents:
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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Next
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*
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