Use this form when submitting for consumer equipment/tank rebates. For all other rebates, use this form. Consumer Equipment Rebate Form Date: * PIN* Association Name* Name*FirstLast Phone Email* Please select *Select Program TypeEE2 ENERGY EFFICIENCY & SAFETY EQUIPMENTRD&D3 FACILITATING & TRANSITIONING ENERGY EFFICIENT EQUIPMENT Upload Rebate Spreadsheet* Total Requested* Payment to*PAYMENT TOASSOCIATIONCONSUMER DIRECTLYCONSUMER DIRECTLY, BUNDLE & RETURN TO ASSOCIATIONSERVICE/INSTALL COMPANY If payment to service/install company, upload W-9 This is for an oil efficiency and upgrade program and I certify that to the maximum extent practicable, I have coordinated, developed and implemented this project with the state energy efficiency administrator.*YesNo I hereby declare the the funds were used in accordance with the National Oilheat Research Act of 2000.*YesNoSubmitReset
