Current Open Forms

2. Town of Erie Energy Efficiency Rebate Application

   Print a copy of this application for your records.

4. First Name
5. Last Name
7. Address1
9. Address2
11. City
12. State
13. Zip
15. Email Address
16. Phone Number
18. Energy Efficiency Measure
    -- Select One --Cold Climate Air Source Heat PumpCold Climate Mini-SplitNon-Cold Climate Air Source Heat PumpNon-Cold Climate MinisplitGround Source Heat PumpHeat Pump Water HeaterEvaporative CoolerInduction CooktopPV SolarSmart ThermostatAttic Insulation and Air SealingBattery BackupEV Home Charger (Level 2 or 3)
20. Receipts

    Upload receipts here

21. Upload More Receipts Here
22. Upload More Receipts Here
24. Before and After Photos (Induction cooktop rebate only)
26. Affadavit

    I swear or affirm under penalty of perjury under the laws of the State of Colorado that (check one): I am a United States citizen and/or I am lawfully present in the United States pursuant to Federal law. I understand that this sworn statement is required by law because I have applied for a public benefit. I understand that state law requires me to provide proof that I am lawfully present in the United States when asked as well as submission of a secure and verifiable document. I may also be required to provide proof of lawful presence. I further acknowledge that making a false, fictitious, or fraudulent statement or representation in this sworn affidavit is punishable under the criminal laws of Colorado as perjury in the second degree under Colorado Revised Statute 18-8-503 and it shall constitute a separate criminal offense each time a public benefit is fraudulently received. By signing this form, I certify that I purchased the fixtures or appliances as stated above and plan to install it (them) at the address indicated above within the Town of Erie service area.

28. Electronic Signature
29. Date
    Date

    Date
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit Submit and Print

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