Wufoo

useoilheatmichigan.com - Dealer Rebate

http://www.useoilheatmichigan.com/dealer-rebate/

Proof of Work (invoice, work order, etc.) *
Certification #1 *
I certify that the customer has been notified that they have received a rebate.
Certification #2 *
I certify that the amount of the rebate is identified on the Proof of Work attached above.
Has your company submitted a rebate this year? *
Yes No
W-9 *
Heating Oil Customer Information
Name * First Last
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Company Information
Name * First Last
Company *
Company Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Number * ### - ### - ####
Email *
To qualify for the rebate, new system must be of higher efficiency than the system that was replaced.
Project Details
Select the Type of Work Done *
Heating Oil Boiler Upgrade Heating Oil Furnace Upgrade Tank Replacement
Heating Oil Boiler Upgrade
Old Boiler
Make *
Model *
Please select one *
There is a tankless coil There is an indirect water heater There is neither a tankless coil nor indirect water heater present
Age of system (if known)
New Boiler
Make *
Model *
Please select one *
There is a tankless coil There is an indirect water heater There is neither a tankless coil nor indirect water heater present
Heating Oil Furnace Upgrade
Old Furnace
Make *
Model *
Age of system (if known)
New Furnace
Make *
Model *
Tank Replacement
Old Tank
Type of Tank Removed *
AST UST
Make *
Model *
New Tank
Type of Tank Installed *
AST UST
Make *
Model *
Are You a Member of MPAMACS? *
Yes No
Authentication *
I certify that I am authorized to submit rebate applications on behalf of my employer.
Do Not Fill This Out

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Wufoo

Heating Oil Customer Information

Company Information

Project Details

Heating Oil Boiler Upgrade

Old Boiler

New Boiler

Heating Oil Furnace Upgrade

Old Furnace

New Furnace

Tank Replacement

Old Tank

New Tank