PSE Rebate Doc Submission

Applicant Information

First name

Last name

Email

Puget Sound Energy (PSE) Account Number

Electric Service Provider (can be found on utility bill)

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

Equipment Information

Equipment Installed (Brand and Model number)

Energy Efficiency Certification

Energy Star

AHRI CEE

Other

Efficiency Ratings

Provide efficiency information for eligible high-efficiency electric equipment (except for electrical service upgrades and wiring). Fill in N/A if not appliable.

Equipment & Efficiency Rating

Air-source Heat Pumps: SEER2/EER2/HSPF2
Heat Pump Water Heaters: Uniform Energy Factor (UEF)
Heat Pump Dryers: Combined Energy Factor (CEF)
Induction cooking equipment: kWh/Year

Cold Climate Certification

NEEP ccASHP

Energy Star

N/A

Uses low-GWP refrigerants

Yes

No

Date of purchase or installation

Month

Day

Year

Warranty Coverage

Applicable building/electrical permit numbers

Contractor Information

Your Company Name

Contact Person

Business Address

Email Address

Total Cost of the project

Amount of rebate or incentive using PSE Decarbonization Funds

Phone Number

Submission Date

Month

Day

Year

Message

Upload Required Documents

If you are a contractor filling out this form on behalf of rebate applicants and have not yet submitted a W-9 to us, please upload it here:

Pictures of equipment before installation

Pictures of newly installed equipment

Installation certification: the applicable building or electrical permit numbers if required for the installation of eligible equipment or appliances

AHRI, CEE, or ENERGY STAR certification documentation for the new equipment

Itemized Invoice (pre-tax equipment and installation costs listed separately)

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 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.

Signature

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

UNITED HUB

PSE/CCA Decarbonization Program
Document Submission

United Hub

UNITED HUB

PSE/CCA Decarbonization Program Document Submission

United Hub

PSE/CCA Decarbonization Program
Document Submission