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2. Name*
3. Groton Utilities Account Number*
5. Address*
7. City*
8. US State*
9. Zip*
11. Mailing Address (If Different)
13. City
14. US State
15. Zip
17. Phone
18. Email*
20. Type of Installation

    1. New Installation (New Home)
    2. New Installation (Existing Home)
    3. Replacement
21. Rebate Payment Method*

    1. Pay directly to contractor
    2. Credit to customer GU account
    3. Check to customer
25. Contractor Information

    Your project may have multiple contractors. Please provide information for all contractors involved. Leave fields for additional contractors empty if unneeded.

27. Contractor Number 1 Company Name*
29. Contractor Number 1 Federal ID Number

    Required if payment is going to contractor

31. Address*
33. City*
34. US State*
35. Zip*
37. Contractor Number 2 Company Name
39. Contractor Number 2 Federal ID Number

    Required if payment is going to contractor.

41. Address
43. City Copy
44. US States
45. Zip
47. Contractor Number 3 Company Name
49. Contractor Number 3 Federal ID Number

    Required if payment is going to contractor.

51. Address
53. City
54. US States
55. Zip
59. New Equipment Information
61. Equipment Type*

    1. Mini-Split
    2. Cooling
    3. Heat Pump Water Heater
62. Install Date*
64. Manufacturer / Brands*
65. Model Numbers*

    For Condenser, Coil and / or Fan for all equipment.

67. Equipment Description*

    Please include quantity of each equipment type, along with tonnage, expected total rebate and any other relevant information.

69. Cooling/HVAC Equipment Information
71. EER/EER2 Rating*
72. SEER/SEER2 Rating*
73. HSPF/HSPF2 Rating*
75. AHRI Reference Number*
77. Heat Pump Water Heater Information
79. Heat Pump Water Heater Energy Star Rating*
80. UEF Rating*
82. File Upload

    Upload sales receipt, installing contractor's invoice, and recent electric bill.

84. Need to upload more files?

    1. Yes
    2. No
86. File Upload#2
88. File Upload#3
90. File Upload#4
92. File Upload#5
Leave This Blank:


93. 1. Receive an email copy of this form.
94. Email address

    This field is not part of the form submission.

95. Submit

* indicates a required field