New ENERGY STAR Qualified Manufactured Home Rebate Application Asterisks (*) indicate required fields.CUSTOMER INFORMATIONAccount Number* Are you the account holder?* Yes No Relationship to Customer (if not account holder)* Family Member Landlord Tenant Name* First Last Phone*Email* Installation Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Do you have a different mailing address?* My mailing address is the same as above I have a different mailing address Mailing Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code HOME INFORMATIONElectric Heat Source* Electric Forced Air Heat Pump Central Air Conditioning* Yes No Square Footage*Manufacturer (brand)* Home Certification Number (VIN or Serial Number)* REBATE INFORMATIONPlease click the button below to find current rebate amounts. This will open a new tab. Rebate Amounts Only brand new manufactured homes with a permanently installed Forced Air Electric Furnace or Heat Pump qualify for this rebate. UPLOAD REQUIRED DOCUMENTSA copy of the Northwest Energy Efficient Manufactured (NEEM) Homes ENERGY STAR qualified compliance certificate must accompany this application.Attach NEEM compliance certificate*Max. file size: 20 MB.Application NotesPlease insert any notes that you would like us to review with your application.SUBMIT YOUR APPLICATIONTerms and Conditions*By clicking "submit," the applicant acknowledges the following: Rebate offer(s) may be changed or discontinued at any time by the Clatskanie PUD (CPUD). CPUD is released of any liability associated with the selection, installation, or operation of the equipment which was purchased under this program, and in no way is CPUD responsible for the safety or satisfactory performance of this equipment. CPUD will not accept any liability caused by customer's participation in this program. CPUD reserves the right to inspect the manufactured home for compliance. I understand the above and certify that I am a customer of CPUD, that the new manufactured home is located at the installation address, and that this address is within the CPUD service territory. I agree Rebate Applications must be submitted within six (6) months of purchase to qualify. Allow 4 to 6 weeks for rebate processing. Call 888-883-9879 to learn about additional energy efficiency programs.