Advanced Programable Thermostat Rebate Form Home Please make sure to complete application and attach a dated invoice. Advanced Programable Thermostat Rebate Form Application must be submitted within 60 days of installation. Incomplete applications will not be accepted. For questions, contact Caitlin Moser at (620) 874-4563 or rebates@weci.net. MEMBER INFORMATION Contact Info Name Email Phone Physical Address Mailing Address City/Town State/Province - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP/Postal Code Wheatland Account Number Personal Residence Landlord Account Rental Property EQUIPMENT INFORMATION New Unit Info - Select -One ThermostatTwo Thermostats Installation Date Unit One Brand Unit One Serial Number Unit Two Brand Unit Two Serial Number Invoice Please attach a copy of the dated receipt or contractor invoice that details all installed equipment information, including brand, model #, and serial #.One file only.20 MB limit.Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, svg. APPLICANT ACKNOWLEDGEMENT Member Signature Please use your mouse (or finger for touch screens) to sign. By signing your name in this box, the Member affirms that the information reflected here is accurate to the best of his or her knowledge and that falsification or reporting of incorrect information on this form is grounds for denial of the rebate.
