Application For Appliance Rebate

We make it easy!

Instructions:

1. Complete the application below
2.Upload a copy of the receipt for the appliance purchased, with the date clearly shown and the appliance and price circled.
3. Application must be completed within 30 days of purchase.

"*" indicates required fields

Your Name*

First Last

Home/Cell Phone Number*

Email Address*

Your Address*

Street Address Address Line 2 City ZIP Code

Is this also your mailing address?*

Yes

Was your gas appliance...

replacing an existing gas appliance?

replacing an electric appliance?

a new gas meter set up?

How did you hear about us*

Natural Gas Provider

Social Media

Radio

Other

Name of your natural gas provider*

Upload a copy of the receipt*

Accepted file types: jpg, gif, png, pdf, Max. file size: 15 MB.

Upload a copy of the receipt for the appliance purchased, with the date clearly shown and the appliance and price circled.

Signature*

CAPTCHA

Name

This field is for validation purposes and should be left unchanged.

Application For Appliance Rebate

We make it easy!

Instructions:

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