2017
rebates
$
up to 100
Programmable &
Wireless Enabled
Thermostat
Residential
rebate form
Program Guidelines
•
•
•
Must purchase a new Wireless Enabled or Programmable Thermostat. Refurbished units are not eligible for rebate. Wireless connection must be enabled
Valid purchases must be made between
January 1, 2017 through December 31, 2017
Maximum rebate cannot exceed purchase price (excluding any taxes)
• Must be a residential natural gas heating or electric customer of a participating Mass Save utility company or energy efficiency service provider
• Rebate form must be received by Mass Save within 60 days from the purchase date
• Rebate paid in the form of a Mass Save Visa®
Prepaid Card
• Please allow 6-8 weeks from receipt of submission for your rebate to be mailed
• To receive your Mass Save prepaid Visa card faster, submit your rebate application online by visiting www.MassSave.com/Rebates
• Some restrictions may apply. Rebate offers are subject to change without notice.
Rebates up to $100
Questions
• 800-232-0672 or email: [email protected]
www.gasnetworks.com
Other than the energy savings realized by Customer, Customer agrees that Program Administrator
has the unilateral right to apply for any credits or payments resulting from the Program or
equipment. Such credits and payments include but are not limited: (a) ISO-NE capacity payments,
(b) other electric or natural gas capacity and avoided cost payments or credits, (c) environmental
credits, and (d) payments from demand response programs. Customer further agrees Customer
will not file for such payments or credits either directly or indirectly, and will not consent to any
other third party’s right to such payments or credits. This right is irrevocable for the life of the
equipment unless the Program Administrator provides written consent.
MassS
www.MassSave.com/Rebates
Natural Gas
Oil
Electric
Propane
Choose One:
UNITIL (MA Only) # __ __ __ __ __ __ __ - __ __ __ __ __ __ __
National Grid Electric (MA Only) # __ __ __ __ __ - __ __ __ __ __
eversource electric (MA Only) # __ __ __ __ __ __ __ __ __ __ __
/
/
/
/
Date Installed
Manufacturer
Model Number
Yes
Yes
No
No
UP TO $100
Self
Contractor
Rebate Amt
up to $25
QTY
Self
Contractor
installed by purchase price
Total Rebate
Online Purchase
date ________________ pRINT NAME ________________________________________ aUTHORIZED Signature ______________________________________________
By your signature above and acceptance of an energy efficiency rebate(s) you acknowledge that the data collected through the use of the wireless enabled thermostat may be shared with your electric and/or gas distribution company
7
I hereby request a rebate for the listed thermostat(s). Attached are copies of all receipts or invoices. I have read and agree to the Terms and Conditions on the reverse side of this form. I certify that the listed equipment has been
installed in accordance with Program Guidelines and Terms and Conditions as described on this form.
Acceptance of terms
Rebate paid in the form of a Mass Save Visa prepaid card. The Visa prepaid card is not redeemable for cash or usable at any ATM. Terms and Conditions apply to the card. Subject to applicable law, a monthly maintenance fee of $3 (USD)
applies, but is waived for the first six months after the card is issued. Cards can be used at any merchants that accept Visa debit cards within the United States and US Territories.
Serial No. ____________________________________________________________ MAC Address ____________________________________________________________
Customers with central AC must provide Serial Number and MAC Address to be eligible for additional offerings.
Programmable
Thermostat
Wireless Enabled
Thermostat
Measure Description
does your home have
a central air cooling
system?
equipment information Limit Two (2) Rebates per Account Complete all the fields for the equipment you have installed. Your invoice must include the same information.
Email: _________________________________________________________________________ Phone: _________________________________________________________
Mailing Address (If different than installed address): ________________________ City: ______________________________________ State: _________ Zip: _________________
Installed Street Address: __________________________________________ City: ______________________________________ State: _________ Zip: _________________
Customer First Name: ___________________________________________________ Customer Last Name: _____________________________________________________
UNITIL (MA Only) # __ __ __ __ __ __ __ - __ __ __ __ __ __ __
National Grid GAS (MA Only) # __ __ __ __ __ - __ __ __ __ __
Owner
Cape light compact # __ __ __ __ - __ __ __ - __ __ __ __
Liberty Utilities (MA Only) # __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
eversource Gas (MA Only) # __ __ __ __ __ __ __ __ __ __ __
COLUMBIA GAS OF MASS # __ __ __ - __ __ __ - __ __ __ - __
BLACKSTONE GAS # __ __ __ __ __ __
BERKSHIRE GAS # __ __ __ __ __ __ __ __ __ __ __ __ __ __ Natural Gas Providers Electric Providers
If payee information is different from account holder information and the gas utility provider is National Grid, additional processing time will be needed for payee verification.
account holder information Heating Fuel Type:
Tenant
To submit your rebate in hard copy, mail the completed rebate
form with all required documents to:
Mass Save Rebates - Thermostats
40 Washington Street, Suite 2000
Westborough, MA 01581
All fields on this page are required to complete your application and missing information will delay your rebate.
To receive your Mass Save Visa® Prepaid Card faster,
submit your rebate online.
Go to www.MassSave.com/Rebates to complete your
online application.
Older thermostats may contain mercury and should be disposed of properly. For more information on mercury and proper disposal visit www.epa.gov/mercury
o Purchase qualifying new Wireless Enabled or Programmable Thermostat
o Apply online at www.MassSave.com/Rebates or complete this application (sign and date). If you have questions, call 800-232-0672
o Valid purchases must be made between January 1, 2017 through December 31, 2017
o Must be a residential natural gas heating or electric customer of a Mass Save utility company or energy efficiency service provider
o Enclose a copy of your dated receipt showing qualifying model, purchase price and paid in full
o Enclose original UPC code from package
o Maximum rebate amount cannot exceed purchase price (excluding any taxes)
to be eligible for the offer
up to $25 Programmable Thermostat Rebate
up to $100 Wireless Enabled Thermostat Rebate