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2. Name*
3. Utilities Account Number*
5. Installation 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. HES Technician Information
22. HES Technician's Name*
24. Phone
25. Email
29. R-value of new insulation*
31. Insulation Information*

    Please include material used, existing insulation R-Value, recommended R-Value, ventilation type and square footage.

33. Rebate Payment Method

    1. Pay directly to contractor
    2. Credit to customer GU/BLP account
    3. Check to customer
35. File Upload*

    Upload documentation listed in the Program Progress section above - MUST include (1) installing contractor's invoice, (2) HES inspection report and (3) most recent electric bill. Maximum of 5 documents. Maximum of 20MB combined documents size. Submissions over 20MB will not be processed. Scan documents rather than take a picture to minimize file size.

37. Need to upload more files?*

    1. Yes
    2. No
39. File Upload#2
41. File Upload#3
43. File Upload#4
45. File Upload#5
Leave This Blank:


47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit

* indicates a required field