Rebate Reward Form^*

Customer First Name*

Customer Middle Name

Customer Last Name*

Mailing Address1*

Address2

City*

State*

Zipcode*

Email*

Account Number* (Verde account number - 9 digit)

Phone Number*

Select Rebate Amount*
—Please choose an option—2550

Select Rebate-cycle
—Please choose an option—Within 90days after your first monthWithin 90days after your 6th month

Upload your bill here

Utility Bill Copy* (only pdf)