Smart Thermostat Rebate

Project Information Form

For Single Family, Multifamily, and Manufactured Home Residential Customers

Instructions: Complete this form and submit it to the PUD. Please include invoice/receipt for device and installation if work was performed by a professional HVAC technician.

Household Information

Jefferson County PUD Customer Name(Required)
Installation Address(Required)
Home Type(Required)

EXISTING EQUIPMENT INFORMATION

One Smart Thermostat per furnace or heat pump controlled with a limit of two per household

Thermostat 1

What heating system is the thermostat controlling?(Required)
Previous Thermostat Type(Required)

Baseboard and zonal heating systems are ineligible for rebate.

Thermostat 2

What heating system is the thermostat controlling?(Required)
Previous Thermostat Type(Required)

Baseboard and zonal heating systems are ineligible for rebate.

(If previous thermostat contains mercury, contact your local waste management or https://thermostat-recycle.org for disposal locations.)

NEW EQUIPMENT INFORMATION

Thermostat 1

MM slash DD slash YYYY
Thermostat Manufacturer(Required)
The thermostat is on the BPA Qualified Products List available at:
Thermostat settings reflect the local geographic area where it has been installed?(Required)
Occupancy detection has been set to "ON"?*(Required)
If the thermostat controls a heat pump, thermostat has been programmed to control a heat pump?*(Required)

*If answered "NO", project is not eligible for incentives.

Reference program Qualified Product List for information on how to properly set occupancy detection.

Reference program Qualified Product List for information on how to properly set auxiliary heat control.

Another Thermostat Installed?
Drop files here or
Accepted file types: jpg, jpeg, gif, png, pdf, heic, doc, docx, Max. file size: 128 MB.
    Did you install yourself?
    Where Should the Rebate Check Be Mailed To?

    Customer Signature

    With my signature below, I certify that I meet all of the above rebate requirements and that the information I have provided is accurate and complete.

    Clear Signature
    This field is for validation purposes and should be left unchanged.