Residential Smart Thermostat 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 INFORMATIONThermostat that controls heat pump has been programmed to control a heat pump:* Yes No Previous thermostat type:* Programmable Manual Home type:* New Construction Site Built Manufactured Multifamily Installer* Contractor Homeowner Installation Date* MM slash DD slash YYYY NEW EQUIPMENT INFORMATIONRebate(s) will not exceed 100% of the total cost and does not cover installation costs. Please click the button below to find current rebate amounts and the qualified products list. This will open a new tab. Rebate AmountsHow many new Smart Thermostats are being installed?* 1 2 Smart Thermostat 1Manufacturer* Model Number* Serial Number* Heating system controlled by Thermostat 1:* Electric Forced Air Furnace Air/Water Source Heat Pump Non-Electric Unfortunately, the thermostat must control an electric heating system to qualify for the rebate.Is the Smart Thermostat programmed to control a heat pump?*(If you have a heat pump, it is required that your Smart Thermostat be programmed to control a heat pump) Yes No Occupancy detection has been set to "ON":*(It is required that you enable occupancy detection) Yes No Smart Thermostat 2Manufacturer* Model Number* Serial Number* Heating system controlled by Thermostat 2:* Electric Forced Air Furnace Air/Water Source Heat Pump Non-Electric Is the Smart Thermostat programmed to control a heat pump?*(If you have a heat pump, it is required that your Smart Thermostat be programmed to control a heat pump) Yes No Unfortunately, the thermostat must control an electric heating system to qualify for the rebate.Occupancy detection has been set to "ON":*(It is required that you enable occupancy detection) Yes No UPLOAD REQUIRED DOCUMENTSUpload your Purchase Receipt(s)*A copy of your purchase receipt(s) for each new Smart Thermostat is required. Purchase receipt(s) should show model number, manufacturer, quantity, date of purchase, and cost. Drop files here or Select files 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 Modern Electric Water Co. Modern disclaims any warranty, whether expressed or implied, regarding the product(s) listed above for any materials or labor associated with installation, maintenance, repair, or any energy savings associated with use. The rebate offer applies to new products only. Modern reserves the right to inspect installed product(s). Product(s) must meet all program criteria to qualify for rebate(s). I understand the above and certify that I am a customer of Modern, that the products are installed & operating at the location indicated. The address is within the Modern service territory. I agree Rebate Applications are due within six (6) months of purchase to qualify. Allow 8 to 10 weeks for the rebate to be applied to your utility account unless otherwise specified. Call 888-883-9879 to learn about additional energy efficiency programs.