High-Efficiency Water Heater Rebate Application
Applicant Information
Full Name
Address
City
State
ZIP Code
Phone Number
Email Address
Water Heater Details
Manufacturer
Model Number
Serial Number
Installation Date
Installer Name
Energy Factor (EF) / UEF
Purchase Information
Purchase Date
Purchase Price ($)
Retailer / Dealer Name
Upload Proof of Purchase
Rebate Details
Rebate Type
Amount