Please read the Program Guidelines & Equipment Requirements before completing this application.

Please have electronic copies of the following documentation available to upload with your application:

• Proof of Purchase
• “Before” Photo of the previous water heater
• Photo of previous water heater nameplate manufacturer label
• “After” Photo of new heat pump water heater installed
• Photo of new heat pump water heater nameplate manufacturer label
• Proof of City of Santa Clara building permit issuance (if applicable)
• W-9 signed within the last 12 months (required for Third-party payment option only)