Water Heater Upgrade Rebate Application

Applicant Information

Full Name Installation Address City State ZIP Code Phone Number Email Address

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Water Heater Information

Type of Old Water Heater Electric Gas Other Old Water Heater Capacity (gallons) Type of New Water Heater Electric Heat Pump Gas Tankless Other New Water Heater Brand/Model New Water Heater Capacity (gallons) Installation Date

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Installer Information

Installer Name/Company Installer Phone Installer License Number

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Documentation

Upload Invoice Upload Photo of New Installation

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Applicant Signature Date