Renewable Energy Water Heater Rebate Form
Applicant Name
Application Date
Installation Address
City
State
ZIP Code
Phone Number
Email Address
Type of Renewable Water Heater System Installed
Solar
Heat Pump
Hybrid
Other
Installation Date
Installer Name/Company
System Make and Model
System Serial Number
Purchase Price
Requested Rebate Amount
Upload Proof of Purchase/Installation
Additional Comments
I certify that the information provided is accurate and complete.