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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. Phone
21. Email
25. Rebate Payment Method*

    1. Credit to Customer GU/BLP Account
    2. Check to Customer
27. Product Information

    Please include the make, model and quantity of the smart thermostat purchased and any other relevant information.

29. File Upload

    Upload documentation listed in the Program Progress section above. 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.

31. Need to upload more files?

    1. Yes
    2. No
33. File Upload#2
35. File Upload#3
37. File Upload#4
39. File Upload#5
Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

* indicates a required field