State Rebate Requests – National Oilheat Research Alliance

For NORA approved trade associations to request payment to contractors or other service providers for approved projects that benefit the industry, please completely fill out and submit this form.

You can include up to three projects with each submitted request as long as the payment is to one party (vendor or association).

This is a multi-page form. Click “Next” at the bottom of each page.

Please note: no single document upload can exceed 3 MB. File formats accepted: jpg, jpeg, png, gif, xls, xlsx, pdf, tif, tiff, csv

Rebate Payments Form

Date: *

PIN*

Association Name*

Name*

First

Last

Phone

Email*

You may enter up to three projects as long as the payment will be made to a single recipient.

Project Categories: CE=Consumer Education, EE=Energy Efficiency, ET=Education & Training, RD&D=Research Development & Demonstration

FIRST Project Amount $*

Select FIRST Project Type*

FIRST Project Description*

Upload FIRST Project Vendor Invoice*

Project Categories: CE=Consumer Education, EE=Energy Efficiency, ET=Education & Training, RD&D=Research Development & Demonstration

Don't have a second submission? Click NEXT.

SECOND Project Amount $

Select SECOND Project Type

SECOND Project Description

Upload SECOND Project Vendor Invoice

Project Categories: CE=Consumer Education, EE=Energy Efficiency, ET=Education & Training, RD&D=Research Development & Demonstration

Don't have a third submission? Click NEXT.

THIRD Project Amount $

Select THIRD Project Type

THIRD Project Description(1)

Upload THIRD Project Vendor Invoice

Total Requested*

Payment to*

Vendor*

Vendor Contact*

First

Last

Vendor Address

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code

Upload Vendor 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.

Yes

I hereby declare the the funds were used in accordance with the National Oilheat Research Act of 2000.*

Yes