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2. Electric Account Number*
4. First Name*
5. Last Name*
7. Address*
9. Phone Number*
11. Email Address*
13. Square footage
15. Heating type

    1. Gas
    2. Electric
16. Cooling type

    1. Central air
    2. Window unit
    3. Heat pump
    4. None
18. Select program you are applying for*
    -- Select One --Solar panelsLevel 2 EV chargingAir conditioner replacementAppliance rebateSmart thermostatHeat pump
20. Solar panel system size (kW)
21. Solar panel installer name
23. Solar panel date placed in service
    Solar panel date placed in service
24. Village of Winnetka permit number
26. Level 2 or 3 EV charging model number
27. Level 2 or 3 EV charging serial number
29. Level 2 or 3 EV charging installer name
30. Level 2 or 3 EV charging date placed in service
    Level 2 or 3 EV charging date placed in service
32. Level 2 or 3 EV charging Winnetka permit number
34. Air conditioner replacement installer name
35. Air conditioner date placed in service
    Air conditioner date placed in service
37. Air conditioner model number
38. Air conditioner serial number
40. Village of Winnetka permit number
41. SEER2 rating
43. EER2 Rating
44. HSPF2 rating

    (must be >=8.1)

46. Appliance rebate
    -- Select One --Induction cooktop/rangeENGERY STAR Heat pump water heaterENERGY STAR Heat pump clothes dryerAutonomous/robot lawn mowerSmart thermostat
47. Appliance brand
49. Appliance model
50. Serial number
52. Appliance brand
53. Appliance model
55. Appliance serial number
56. Heat pump brand
58. Heat pump model number
59. Model year
61. Heat pump type
    -- Select One --DuctedDuctlessMinisplit
62. Reason for installation

    1. Replaces a furnace or boiler
    2. Replaces something other than a furnace or boiler
64. Cooling capacity (BTU/hr)
65. Heating capacity (BTU/hr)
67. Purchase date
    Purchase date
68. Installation date
    Installation date
70. Purchase price
72. Upload receipt(s)
74. Upload Spec Sheet
76. Upload final inspection report (if required)
Leave This Blank:


78. 1. Receive an email copy of this form.
79. Email address

    This field is not part of the form submission.

80. Submit

* indicates a required field