Program Guidelines• Must purchase a new Programmable or Wireless • Must purchase a new Programmable or Wireless Enabled Thermostat. (Refurbished units are not Enabled Thermostat. (Refurbished units are not eligible for rebate). eligible for rebate). (Wireless connection must (Wireless connection must be enabled) be enabled)

• Valid purchases must be made between • Valid purchases must be made between January 1, 2016 through December 31, 2016 January 1, 2016 through December 31, 2016

• Maximum rebate cannot exceed purchase price• Maximum rebate cannot exceed purchase price

• • Must be a residential natural gas heating or electric Must be a residential natural gas heating or electric customer of a participating Mass Save utility customer of a participating Mass Save utility company or energy effi ciency service provider company or energy effi ciency service provider

• • Limit two (2) rebates per account per calendar year.Limit two (2) rebates per account per calendar year. Additional rebates require pre-approval. Pre-approval can be Additional rebates require pre-approval. Pre-approval can be requested by contacting MassSaveRebates@efi .org requested by contacting MassSaveRebates@efi .org

• Rebate form must be received by • Rebate form must be received by Mass Save within Mass Save within 60 days from the purchase date 60 days from the purchase date

• Rebate paid in the form of a Mass Save Visa® • Rebate paid in the form of a Mass Save Visa® Prepaid Card Prepaid Card

• Please allow 6-8 weeks from receipt of submission for • Please allow 6-8 weeks from receipt of submission for your rebate to be mailed your rebate to be mailed

• To receive your Mass Save prepaid Visa card faster, • To receive your Mass Save prepaid Visa card faster, submit your rebate application online by visiting submit your rebate application online by visiting www.MassSave.com/Rebates

• Some restrictions may apply. Rebate off ers are • Some restrictions may apply. Rebate off ers are subject to change without notice. subject to change without notice. QuestionsQuestions• 800-232-0672 or email: • 800-232-0672 or email: MassSaveRebates@efi .org MassSaveRebates@efi .org

REBATESup to $100

Programmable Thermostats Up to $25Wireless Enabled Thermostats Up to $100

Programmable & Wireless Enabled

Thermostats

2016 REBATES FOR RESIDENTIAL

HEATING CUSTOMERS

m Guidelinesm Guidelines

www.gasnetworks.com

REBATESup to $100

Programmable Thermostats Up to $25Wireless Enabled Thermostats Up to $100

www.masssave.com

ACCOUNT HOLDER INFORMATION ACCOUNT HOLDER INFORMATION Heating Fuel Type: Natural Gas Oil Electric Propane Heating Fuel Type: Natural Gas Oil Electric Propane Choose One:Choose One: OwnerOwner TenantTenant

Natural Gas Providers Electric Providers

BERKSHIRE GAS # __ __ __ __ __ __ __ __ __ __ __ __ __ __ CAPE LIGHT COMPACT # __ __ __ __ - __ __ __ - __ __ __ __

BLACKSTONE GAS # __ __ __ __ __ __ EVERSOURCE ELECTRIC (MA Only) # __ __ __ __ __ __ __ __ __ __ __

COLUMBIA GAS OF MASSACHUSETTS # __ __ __ __ __ __ __ __ __ __ NATIONAL GRID ELECTRIC (MA Only) # __ __ __ __ __ - __ __ __ __ __

EVERSOURCE GAS (MA Only) # __ __ __ __ __ __ __ __ __ __ __ UNITIL (MA Only) # __ __ __ __ __ __ __ - __ __ __ __ __ __ __

LIBERTY UTILITIES (MA Only) # __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

NATIONAL GRID GAS (MA Only) # __ __ __ __ __ - __ __ __ __ __

UNITIL (MA Only) # __ __ __ __ __ __ __ - __ __ __ __ __ __ ________________________________________________________________________________________________________________________________CUSTOMER FIRST NAME CUSTOMER LAST NAME

______________________________________________________________________________________________________________________________INSTALLED STREET ADDRESS CITY STATE ZIP

______________________________________________________________________________________________________________________________MAILING ADDRESS (IF DIFFERENT THAN INSTALLED ADDRESS) CITY STATE ZIP ______________________________________________________________________________________________________________________________ EMAIL TELEPHONE ______________________________________________________________________________________________________________________________

To receive your Mass Save Visa® Prepaid Card faster,

submit your rebate online.

Go to www.MassSave.com/Rebates to complete your online application.

I hereby request a rebate for the listed thermostat(s). Attached are copies of all receipts or invoices. I have read and agree to the Terms and Conditions on the reverse side of this form. I certify that the listed equipment has been I hereby request a rebate for the listed thermostat(s). Attached are copies of all receipts or invoices. I have read and agree to the Terms and Conditions on the reverse side of this form. I certify that the listed equipment has been installed in accordance with Program Guidelines and Terms and Conditions as described on this form.installed in accordance with Program Guidelines and Terms and Conditions as described on this form.

DATE _________________ PRINT NAME _________________________________________ AUTHORIZED SIGNATURE ________________________________________________DATE _________________ PRINT NAME _________________________________________ AUTHORIZED SIGNATURE ________________________________________________

By your signature above and acceptance of an energy effi ciency rebate(s) you acknowledge that the data collected through the use of the wireless enabled thermostat may be shared with your electric and/or gas distribution companyBy your signature above and acceptance of an energy effi ciency rebate(s) you acknowledge that the data collected through the use of the wireless enabled thermostat may be shared with your electric and/or gas distribution company

ACCEPTANCE OF TERMS

MEASURE DESCRIPTION DATE INSTALLED MANUFACTURER MODEL NUMBER INSTALLED BY PURCHASE PRICE QTY REBATE AMT TOTAL REBATE MEASURE DESCRIPTION DATE INSTALLED MANUFACTURER MODEL NUMBER INSTALLED BY PURCHASE PRICE QTY REBATE AMT TOTAL REBATE

Programmable UP TO $25UP TO $25Thermostat

Wireless Enabled UP TO $100UP TO $100

EQUIPMENT INFORMATION Limit Two (2) Rebates per Account Online Purchase

/ // /

/ // /

DOES YOUR HOME HAVE DOES YOUR HOME HAVE A CENTRAL AIR COOLING A CENTRAL AIR COOLING

SYSTEM?SYSTEM?

Rebate paid in the form of a Mass Save Visa prepaid card. The Visa prepaid card is not redeemable for cash or usable at any ATM. Terms and Conditions apply to the card. Subject to applicable law, a monthly maintenance fee of $3 (USD) Rebate paid in the form of a Mass Save Visa prepaid card. The Visa prepaid card is not redeemable for cash or usable at any ATM. Terms and Conditions apply to the card. Subject to applicable law, a monthly maintenance fee of $3 (USD) applies, but is waived for the fi rst six months after the card is issued. Cards can be used at any merchants that accept Visa debit cards within the United States and US Territories. applies, but is waived for the fi rst six months after the card is issued. Cards can be used at any merchants that accept Visa debit cards within the United States and US Territories.

Yes No Yes No

Yes No Yes No

Self Self ContractorContractor

Self Self ContractorContractor

UP TO$25 Programmable Thermostat Rebate

UP TO $100 Wireless Enabled Thermostat Rebate

TO BE ELIGIBLE FOR THE OFFER

Mass Save Rebates - Thermostats 40 Washington Street, Suite 2000 Westborough, MA 01581

To submit your rebate in hard copy, mail the completed rebate form with all required documents to:

All fi elds on this page are required to complete your application and missing information will delay your rebate.

Older thermostats may contain mercury and should be disposed of properly. For more information on mercury and proper disposal visit www.epa.gov/mercury

If payee information is diff erent from account holder information and the gas utility provider is National Grid, additional processing time will be needed for payee verifi cation.If payee information is diff erent from account holder information and the gas utility provider is National Grid, additional processing time will be needed for payee verifi cation.

7

Complete all the fi elds for the equipment you have installed. Your invoice must include the same information.Complete all the fi elds for the equipment you have installed. Your invoice must include the same information.

Customers with central AC must provide Serial Number and MAC Address to be eligible for additional off erings. Customers with central AC must provide Serial Number and MAC Address to be eligible for additional off erings.

SERIAL NO. SERIAL NO. ________________________________________________________________________________________________________________________ MAC ADDRESSMAC ADDRESS ________________________________________________________________________________________________________________________

Thermostat

o Purchase qualifying new Programmable or Wireless Enabled Thermostato Complete rebate form, sign and dateo Valid purchases must be made between January 1, 2016 through December 31, 2016 o Must be a residential natural gas heating or electric customer of a Mass Save utility company or energy effi ciency service providero Enclose a copy of your dated receipt showing qualifying model, purchase price and paid in fullo Enclose UPC code from packageo Maximum rebate amount cannot exceed purchase price