Rebate Application - Smart Thermostat

All account information will be kept confidential between the Cooperative, Associated Electric Cooperative and agents acting on their behalf.

Name: *

Co-op Account Number: *

Phone Number *

Area Code Phone Number

Email address: *

example@example.com

Install date: *

Date

Address (where unit is installed) *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Is the mailing address different than the installed address? *

Yes No

Mailing address (if different than installed address) *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Primary or vacation home? *

Primary Home Vacation Home

New or existing home? *

New home Existing home

Is this a rental property? *

Yes No

Did the rebate influence your purchase decision? *

Yes No

How many people live in the home? *

Home type: *

Single family Multi-family Town home Condo Other

Primary method to heat your home: *

Gas-forced air Electric-forced air Electric baseboard Air source heat pump Ground source heat pump

Primary method to cool your home: *

Central air Window air None Air source heat pump Ground source heat pump

APPLIANCE INFORMATION - Type "Unsure" or "N/A" if not applicable. *

UNIT 1

UNIT 2

MANUFACTURER:

MODEL:

COOLING TONS CONTROLLED:

SEER OF UNIT

Attach a copy of receipt: *

Browse Files

FILE TYPES ACCEPTED: PDF, ZIP, JPG, PNG

IMPORTANT TERMS AND CONDITIONS

Please allow 6-8 weeks for processing. Limit two rebates per address. Please keep a copy for your records.
The appliance must be installed where electricity is supplied by the Cooperative.
Rebates are limited to eligible services (homes, lake homes, shops, barns, etc) that purchase more than 6,000 kilowatt-hours of electricity from the Cooperative on an annual basis.
You must include a copy of the original dated sales receipt with this application.
Include your account number and sign the form
Please complete a separate application for each installation site
Incomplete applications will not be processed for rebates
Recipients of rebates may be requested to participate in a future survey by e-mail or by phone.
Submit completed application and sales receipt within 90 days of purchase to your local electric cooperative.
Additional eligibility requirements are on the back of this application

ELIGIBILITY CRITERIA

Must be a member in good standing with the cooperative
The thermostat must be ENERGY STAR® rated
Rebates may be subject to cooperative load control programs
The participant agrees to allow the cooperative to control their heating and cooling equipment now or in the future.
Limit of up to two (2) per member address/location
Rebates are available for existing and new homes
The rebate amount is limited to 50 percent (50%) of the total cost of the unit

DISCLAIMER

The cooperative is not responsible if your contractor, retailer, builder or other party provides you with inaccurate information about the amount or conditions of the actual rebate. The cooperative will not rebate equipment that has been mislabeled, misrepresented or previously owned. The cooperative reserves the right to inspect the equipment and its installation at the address indicated on the front of this application. The cooperative is not responsible for any lost, late, stolen, ineligible, misdirected or postage due mail. All completed applications will become the property of the cooperative. Rebate qualifications and amounts are subject to change at the cooperative’s discretion and the program may end at any time without notice.

Do you accept the terms, conditions and qualifications above? *

Yes No

Please accept before proceeding.

MEMBER SIGNATURE (Certifies that the appliance(s)/unit(s) listed meet program requirements and that they are installed at the address listed. I agree that the cooperative may verify installation at the address listed.) *

E-Signature must exactly match name as it appears above.

SMART THERMOSTAT REBATE APPLICATION

MEMBER INFORMATION

RESIDENTIAL INFORMATION

REBATE QUALIFICATIONS