Cash Rebate Form

Name

Parcel ID Number

Mailing Address

Address line 2

City

Zip Code

State

Preferred Method of Communication

Incentive Information

Electric to Gas Water Heater Conversion Plus Additional Appliances

Tankless Water Heater

Tank Water Heater

Furnace

Piping Subsidy - BUILDER

For builder rebate purposes, please list additional quantities of appliances here. For example, two tankless water heaters.

*Attach Receipt Here (receipt must be submitted before rebate is paid) (required)

Attach Additional Receipts Here (receipt must be submitted before rebate is paid) (required)

Attach Additional Receipts Here (receipt must be submitted before rebate is paid)