SAGE Rebate Application

SAGE Rebate Application
Business Information
Business Name*
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Payee for Rebate for Recipient Business

Designate to whom the rebate check should be made payable and to where the check should be sent.
Point of Contact for Recipient Business*

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Rebates Selection

Check all applicable rebates you’re applying for and describe project under each selection
Energy

LightingHVACRefrigerationMotors, pumps, and fansBuilding Operator CertificationOther
Energy Description
All upgrades must be ENERGYSTAR, Xcel Energy certified, or of similar high efficiency. The total combined the Recipient Business may receive for energy rebates is up to 75% of total project cost, capped at $1,500/year.
Water

ToiletUrinalSmart Irrigation ControllerOther
Water Description
All upgrades should be WaterSense certified or similarly high-efficiency equipment. Each product category is eligible to receive up to 75% of total cost rebated, capped at $500 for each product/item.
Waste

2-3 bin waste collection system (i.e. trash and/or recycling and compost collection bins)Compostable and/or recyclable take-out containers, utensils, napkins, cups, and other food reciprocalsEnrollment in a new recycling and/or compost service
Waste Description
Each item is eligible to receive up to 75% of total cost rebated, capped at $500 for each.
Reusables (Each business is eligible to receive up to 75% of total cost rebated, capped at $1,000 for each)

Durable dishware (plates/service ware, etc.)Reusable takeout containers (cups/jars/etc.)Dishwashers (WaterSense Certified)Reusable take-out containers, utensils cups, and other food reciprocals:Other
Reusables Description
Reusables Description - Describe the following:
- Please provide details of what you will be buying with this grant.
- What single-use items would this allow you to reduce? (include an estimate of how much will be reduced over the course of a year or month-to-month)
- Please provide any additional details about what systems you might put in place to maximize success.
Transportation

Transit Passes/RTD Eco-pass (Up to 75% of total cost rebated, capped at $500)EV Charging Station: Public level 1-3 (Up to 75% project cost, capped at $1,500)Other
Transportation Description
Custom Rebate
Describe your custom project that does not fit into the categories above. Please include how this project will reduce the use of natural resources (e.g. energy and water), save your business money, and/or improve the sustainability of your business.

Up to 75% project cost, capped at $1,500 for total project costs.
Upload Receipts/Invoices

Cancelof
Upload Photos/Visual Documentation of Project

Cancelof
Terms and Conditions
Acknowledgement*

I have read the below “Terms and Conditions” which have been set by the City of Westminster and acknowledge below that I have read, understood, and agree to follow them.
Click here to view the Terms and Conditions.
Electronic Signature
I agree that the information I have provided in this application is truthful and accurate and that checking this box and entering my information below constitutes a legal and enforceable signature for this application in accordance with the provisions of the provisions of the Colorado Electronic Signatures Act 24-71-101.*

Agree
Full Name (Including middle initial if applicable)*
Address*
Email*
example@example.com
Date Received

MonthDayYear
Date
Hour MinutesAM/PM Option
Application Approved

YesNo
Approval Date

MonthDayYear
Date
Amount Approved
Project Verified
Amount Paid
Date Paid

MonthDayYear
Date
Owner

Bridger Tomlin - Sustainability Associate
Should be Empty:

SAGE Rebate Application

Business Information

Payee for Rebate for Recipient Business

Rebates Selection

Terms and Conditions

Electronic Signature

Owner