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2. Utility Rebate Program Timeline:
   • Jan.-Sept. 2023: Applications may be submitted until Oct. 31, 2023. Please remember that you must be enrolled in PSE HELP in order to be eligible for the Issaquah Utility Rebate Program. This process may take a couple of months.
   • Aug.-Oct. 2023: Confirmation of Program Eligibility will be made approximately within 30-45 days from submission. Applicants deemed not eligible or if their eligibility cannot be confirmed will be contacted to provide proof of enrollment in the PSE HELP.
   • Oct.-Dec. 2023: The City of Issaquah will process applications and mail rebate payment by Dec. 31, 2023.
4. Reminder: Before submitting this form, be sure you are enrolled in the Puget Sound Energy's PSE HELP program.
   PSE HELP Program
6. First Name*
7. Last Name*
9. Service Address*
11. Service Address 2
13. City*
14. State*
15. Zip*
17. Mailing Address
19. Mailing Address 2
21. City
22. State
23. Zip
25. PSE Account Number*
26. Phone Number*
27. Email Address
29. I acknowledge that I have lived within Issaquah City limits for the previous 12 months.*

    1. I agree
31. By this release, I authorize the City of Issaquah to request and obtain from Puget Sound Energy and Hopelink confirmation of my enrollment in the PSE HELP Program within the most recent program year. This information is solely limited to confirmation of my participation in the PSE HELP program and does not extend to any other personal identifiable information including financial records, disability, or specific household information. I authorize Puget Sound Energy/Hopelink to provide the requested information to the City of Issaquah by presenting this release. I am being advised that any information requested and provided will be used only for the purposes of verifying my eligibility for the Utility Discount Program offered by the City of Issaquah. I release Puget Sound Energy, Hopelink and the City of Issaquah from any and all liability for actual or alleged damages to me as a result of good faith compliance with this authorization. This authorization expires at the end of my participation in the City of Issaquah’s Utility Discount Program. *

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

    This field is not part of the form submission.

35. Submit

* indicates a required field