Energy Efficient Manufactured Home Rebate Application

Fill out the form below online or click here to download the form

** If you choose to download the form, please fill out, scan and send to ahout@missionvalleypower.org

Energy Efficient Manufactured Home Incentive Program

Conservation Rebate form Energy Efficient Manufactured Homes

Date(Required)

Account #(Required)

Location Number

Name(Required)

First Last

Phone Number:(Required)

Phone # of Residence if different:

Email Address:

Mailing Address(Required)

Street Address City State ZIP Code

Install Address(Required)

Address where MAP Home is installed:

Street Address City State ZIP Code

Manufacturer:(Required)

Serial Number:(Required)

SGC#(Required)

HUD Number:(Required)

HUD Number:

Dealer:

Sales Rep:

Pay the above Sales Rep or Dealer the Sum of $150.00.(Required)

Yes

Sales Rep or Dealer Address(Required)

Street Address City State ZIP Code

Sales Rep or Dealer Phone:(Required)

Sales Rep or Dealer SS# or Tax ID#:(Required)

Total Rebate Amount Due ($1000.00/MAP Home):

Payment Option:(Required)

Billing Credit

Rebate Check

Customer SS# or Tax ID#(Required)

Copy of Receipt of Purchase(Required)

Accepted file types: jpg, pdf, png, gif, jpeg, tiff, Max. file size: 10 MB.

State Energy Office Certificate of Compliance (NEEM Cert):(Required)

Accepted file types: jpg, pdf, png, gif, jpeg, tiff, Max. file size: 10 MB.

I certify that this MAP home was purchased and installed at the above address. I will allow a representative of Mission Valley Power and/or Bonneville Power Administration to verify site installation.

Customer Signature:(Required)

Sales Rep or Dealer Signature:(Required)

Name

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

Please allow up to 8 weeks for the billing credit to be issued to your account after submitting your completed application and all required documentation.

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Drive Thru Hours

After Hours 406-883-7972

Office 406-883-7900

After Hours 406-883-7972

Office 406-883-7900

Energy Efficient Manufactured Home Rebate Application

Fill out the form below online or click here to download the form

Energy Efficient Manufactured Home Incentive Program

I certify that this MAP home was purchased and installed at the above address. I will allow a representative of Mission Valley Power and/or Bonneville Power Administration to verify site installation.

Please allow up to 8 weeks for the billing credit to be issued to your account after submitting your completed application and all required documentation.

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