Insulation Rebate Application

All sections must be filled out, signed, and dated by the building owner. An incomplete form will not be processed. Submit a completed application with a receipt or contractor invoice and before and after photos. Qualifying Insulation must be properly installed in an existing site-built dwelling unit with a primary electrical heat source to qualify. Programs are subject to change or cancellation without notice. Application must be submitted within 12 months of project completion.

Customer Name*

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Email*

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Meter Number*

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Installation Date*

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Installation Site Address*

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City*

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Contact Phone #*

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Mailing Address*

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City*

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State*

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Zip*

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Please check here to have rebate sent as an ACH direct deposit

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Primary Building Heat Source:*

Please Specify*

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Existing Insulation Level

Attic R-

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/sq ft

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Crawl Space R

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/sq ft

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Insulation Installed Level

Attic R-

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/sq ft

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Crawl Space R

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/sq ft

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Invoice Provided

Bag Count Left in Attic and Provided to PUD (if applicable)

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Contractor Name

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Project Cost

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Owner:

By signing below, you are certifying the building’s primary heat source as noted above. I, if requested, will allow a representative of Grant County PUD to verify the installation of the measure.

Print Name*

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Signature*

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Date*

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*

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