Energy Efficiency Rebate Form
Please fill in all required fields. If you have any questions, please give us a call at 770-786-3484 or contact us on www.ssemc.com
Contact Information
First Name:
*
Last Name:
*
Account Number:
*
Service Address
*
City:
*
Zip:
*
Email Address
*
Phone Number:
*
Rebate Information
Equipment Type:
*
HVAC/Heat Pump
Water Heater
HVAC/Heat Pump
Water Heater
Did You Convert from Gas to Electric?:
*
Yes
No
Yes
No
Purchased Within Last 90 days?:
*
Yes
No
Yes
No
Date Equipment Purchased:
*
Equipment Installed?:
*
Yes
No
Yes
No
Do You Have A Receipt/Proof of Purchase?:
*
Yes
No
Yes
No
Photo of Receipt:
*
Drop files here, or
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Photo of Data Plate on Outdoor Unit:
*
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Photo of AHRI Certificate:
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View AHRI Certificate Example here
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