Form Center

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

    1. New Installation (New Home)
    2. New Installation (Existing Home)
    3. Replacement
22. Contractor Information
24. Contractor Federal ID Number*
25. Contractor Company Name*
27. Address*
29. City
30. US States
31. Zip
33. Mailing Address (If different)
35. City
36. US States
37. Zip
39. Phone
40. Email
44. Rebate Payment Method*

    1. Pay directly to contractor
    2. Credit to customer GU/BLP Account
    3. Check to customer
46. Equipment Description

    Please include quantity, manufacturer, model numbers, size, installation date and general description of equipment.

    If more than one equipment item listed please enter ratings for each equipment item in the following fields.

    
    

50. EER Rating Number 1*
51. SEER Rating Number 1*
52. HSPF Rating Number 1*
54. EER Rating Number 2
55. SEER Rating Number 2
56. HSPF Rating Number 2
58. EER Rating Number 3
59. SEER Rating Number 3
60. HSPF Rating Number 3
62. File Upload

    Upload sales receipt, installing contractor's invoice, manufacturer invoice of condenser, AHRI certificate and 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.

64. Need to upload more files?

    1. Yes
    2. No
66. File Upload#2
68. File Upload#3
70. File Upload#4
72. File Upload#5
Leave This Blank:


74. 1. Receive an email copy of this form.
75. Email address

    This field is not part of the form submission.

76. Submit

* indicates a required field