WMGLD Wi-Fi Smart Thermostat Form

Customer Information

WMGLD Customer Name (required)

12-digit WMGLD Account Number (required)

Email (required)

Phone

Installation address (please do not list P.O. Box#)

Street Address

City/town

State

Zip

Store and Product Information

Store Name

Street Address

City/Town

Zip

Purchase Price

Purchase Date

Manufacturer
EcobeeHoneywellNestSenisibo

Model #

Type of Heating Fuel at Residence:
Gas (from Municipal)ElectricHeat pumpsDuctless Mini-split

Other type of Heating Fuel:

Does Your Home have a Central Air Cooling System:
YesNo

Is your house Wi-Fi enabled?
yesno

Please attach a copy of your dated sales receipt (must show qualifying model, purchase price and paid in full) and the UPC Code from
Package

Attachment (6MB max.):

Attachment (6MB max.):

Additional Restrictions:

• Only residential customers with an active WMGLD account are eligible to
  participate
• Only customers residing in 1-4 unit residences are eligible to participate
• Limit one rebate per customer per year
• The WMGLD reserves the right to conduct field inspections to verify installations

Rebate will be applied directly to customer account as a credit. Please allow one to two billing cycles for your credit to appear on you bill.

By clicking "Submit Form" you agree that all information provided is accurate to the best of your ability.

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