800-232-0672 MassSave.com/Rebates

2018

Residential Rebate foRm

Program Guidelines• Must purchase and install a new Wireless Enabled or Programmable Thermostat. Refurbished units are not eligible for rebate. Wireless connection must be enabled• Valid purchases and installations must be made between January 1, 2018 through December 31, 2018• Maximum rebate cannot exceed purchase price (excluding any taxes)

• Must be a residential natural gas heating or electric customer of a participating Mass Save utility company or energy efficiency service provider• Rebate form must be received by Mass Save within 60 days from the purchase date• Rebate paid in the form of a Mass Save Visa® Prepaid Card • Please allow 6-8 weeks from receipt of submission for your rebate to be mailed• To receive your Mass Save prepaid Visa card faster, submit your rebate application online by visiting www.MassSave.com/Rebates• Some restrictions may apply. Rebate offers are subject to change without notice. Questions• 800-232-0672 or email: MassSaveRebates@efi.org

Other than the energy savings realized by Customer, Customer agrees that Program Administrator has the unilateral right to apply for any credits or payments resulting from the Program or equipment. Such credits and payments include but are not limited: (a) ISO-NE capacity payments, (b) other electric or natural gas capacity and avoided cost payments or credits, (c) environmental credits, and (d) payments from demand response programs. Customer further agrees Customer will not file for such payments or credits either directly or indirectly, and will not consent to any other third party’s right to such payments or credits. This right is irrevocable for the life of the equipment unless the Program Administrator provides written consent.

Rebates up to $125

www.gasnetworks.com

Rebates up to $125

www.masssave.com/Rebates

Programmable & Wireless enabled ThermosTaT

account holder information Heating Fuel Type: Natural Gas Oil Electric Propane Choose One: Owner Tenant

natural Gas Providers electric Providers

BERKSHIRE GAS # __ __ __ __ __ __ __ __ __ __ __ __ __ __ CApE lIGHt CompACt # __ __ __ __ - __ __ __ - __ __ __ __

BlACKStoNE GAS # __ __ __ __ __ __ EvERSouRCE ElECtRIC (mA only) # __ __ __ __ __ __ __ __ __ __ __

ColumBIA GAS oF mASS # __ __ __ - __ __ __ - __ __ __ - __ NAtIoNAl GRId ElECtRIC (mA only) # __ __ __ __ __ - __ __ __ __ __

EvERSouRCE GAS (mA only) # __ __ __ __ __ __ __ __ __ __ __ uNItIl (mA only) # __ __ __ - __ __ __ __ . __ __ __

lIBERty utIlItIES (mA only) # __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

NAtIoNAl GRId GAS (mA only) # __ __ __ __ __ - __ __ __ __ __

uNItIl (mA only) # __ __ __ - __ __ __ __ . __ __ __

Customer First Name: ___________________________________________________ Customer last Name: _____________________________________________________

Installed Street Address: (Must match account service address)_________________________________ City: _____________________________ State: _______ Zip: ___________

mailing Address (If different than installed address): _________________________________________ City: _____________________________ State: _______ Zip: ___________

Email: _________________________________________________________________________ phone: _________________________________________________________

to receive your mass Save Visa® Prepaid card faster, submit your rebate online. Go to www.massSave.com/rebates to complete your online application.

I hereby request a rebate for the listed thermostat(s). Attached are copies of all receipts or invoices. I have read and agree to the Terms and Conditions on the reverse side of this form. I certify that the listed equipment has been installed in accordance with Program Guidelines and Terms and Conditions as described on this form.

daTe ________________ pRINT NaMe ________________________________________ aUTHORIZed SIgNaTURe ______________________________________________

By your signature above and acceptance of an energy efficiency rebate(s) you acknowledge that the data collected through the use of the wireless enabled thermostat may be shared with your electric and/or gas distribution company

MEAsurE DEsCrIPTION DATE INsTAllED MANuFACTurEr MODEl NuMbEr INsTAllED by PurCHAsE PrICE QTy RebaTe aMT TOTAl rEbATE

Wireless enabled Thermostat

Wireless enabled

/ /

/ /

DOEs yOur HOME HAvE A CENTrAl AIr COOlING

sysTEM?

rebate paid in the form of a Mass save visa prepaid card. The visa prepaid card is not redeemable for cash or usable at any ATM. Terms and Conditions apply to the card. subject to applicable law, a monthly maintenance fee of $3 (usD) applies, but is waived for the first six months after the card is issued. Cards can be used at any merchants that accept visa debit cards within the united states and us Territories.

yes No

yes No

self Contractor

up to $25 Programmable thermostat Rebateup to $125 Wireless enabled thermostat Rebate

to be eliGible for the offer

mass Save Rebates - thermostats p.o. Box 2528 manchester, Ct 06045

to submit your rebate in hard copy, mail the completed rebate form with all required documents to:

All fields on this page are required to complete your application and missing information will delay your rebate.

Older thermostats may contain mercury and should be disposed of properly. For more information on mercury and proper disposal visit www.epa.gov/mercury

If payee information is different from account holder information and the gas utility provider is National Grid, additional processing time will be needed for payee verification.

7

Complete all the fields for the equipment you have installed. If installed by contractor your invoice must include the same information.

For Wireless Enabled Thermostats only. Customers with central AC must provide serial Number and MAC Address to be eligible for additional offerings.

sErIAl NO. ____________________________________________________________ MAC ADDrEss ____________________________________________________________

Thermostat

o purchase qualifying new Wireless Enabled or programmable thermostat o Apply online at www.massSave.com/rebates or complete this application (sign and date). If you have questions, call 800-232-0672o valid purchases and installations must be made between January 1, 2018 through december 31, 2018 o must be a residential natural gas heating or electric customer of a mass Save utility company or energy efficiency service providero Enclose a copy of your dated receipt showing qualifying model, purchase price and paid in fullo Enclose original upC code from packageo maximum rebate amount cannot exceed purchase price (excluding any taxes)

self Contractor

uP TO $100

accePtance of termS

uP TO $25

* Visit MassSave.com/Thermostats for the most current list of qualifying thermostat manufacturers.

(Honeywell, ecobee and simple only*)

uP TO $125

programmable Thermostat / /

yes No self Contractor

equiPment information rebate not to exceed purchase price. limit two (2) rebates per Service address Online Purchase