PSE Heat Pump Rebate Application

First name

Last name

Email

Phone

Puget Sound Energy (PSE) Account Number

Electric Service Provider

Installation Street Address

Please provide the complete address where the equipment will be/has been installed. Incomplete information will not be processed.

Installation City

Please provide the complete address where the equipment will be/has been installed. Incomplete information will not be processed.

Installation Zip Code

Do you live at the installation address?

Yes

No

Your annual household gross income

Number of people in your household

What year was the building constructed in?

Housing Status

Own

Rent

Other

Landlord's approval is required if you a tenant and are renting the property.

By checking this box, I agree that I've reviewed and accepted the Terms and Conditions and have reviewed the Program Guidelines

By checking this box, I agree to provide my income verification and to coordinate with the audit if requested.

By checking this box, I agree that false, misleading, or incomplete information may render the customer ineligible to participate in UNITED HUB's PSE rebates. If any information provided in connection with the UNITED HUB PSE program is found to be false, UNITED HUB reserves the right to require reimbursement of any incentives provided. UNITED HUB reserves the right to request additional documentation or proof of income to verify income qualification.

Message

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

UNITED HUB

PSE/CCA Decarbonization Program Application

United Hub