Smart Thermostat Rebate Form
Please fill in all required fields. If you have an questions, please give us a call at 770-385-2875 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
Brand of Thermostat:
*
Ecobee
Honeywell
Nest
Other
Ecobee
Honeywell
Nest
Other
Purchased within the last 90 days?
*
Yes
No
Yes
No
Date Equipment Purchased:
*
Date Equipment Installed
*
Is Wifi Capable?
*
Yes
Yes
Photo of Receipt:
*
Drop files here, or
browse to attach files
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Confirmation Required
Are you sure you want to remove the selected file?
Confirm
Cancel
Photo of Installation:
*
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browse to attach files
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Confirmation Required
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Confirm
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