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2. Business Information
4. Business Name*
6. Business Address
8. Street Address*
10. Street Address Line 2
12. City*
13. State / Province*
15. Postal / Zip Code*
17. Payee for Rebate for Recipient Business

    Designate to whom the rebate check should be made payable and to where the check should be sent.

19. Point of Contact for Recipient Business
21. First Name*
22. Last Name*
24. Phone Number
26. Email
30. Rebates Selection

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

32. Energy

    1. Lighting
    2. HVAC
    3. Refrigeration
    4. Motors, pumps, and fans
    5. Building Operator Certification
    6. Other
34. 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.

38. Water

    1. Toilet
    2. Urinal
    3. Smart Irrigation Controller
    4. Other
40. 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. 

44. Reusables (Each business is eligible to receive up to 75% of total cost rebated, capped at $1,000 for each)

    1. Durable dishware (plates/service ware, etc.)
    2. Reusable takeout containers (cups/jars/etc.)
    3. Dishwashers (WaterSense Certified)
    4. Reusable take-out containers, utensils cups, and other food reciprocals
    5. Other
46. 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.
50. Transportation

    1. Transit Passes/RTD Eco-pass (Up to 75% of total cost rebated, capped at $500)
    2. EV Charging Station: Public level 1-3 (Up to 75% project cost, capped at $1,500)
    3. Other
52. Transportation Description
56. 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.

58. Upload Receipts/Invoices
60. Upload Photos/Visual Documentation of Project
64. Terms and Conditions
66. Acknowledgement

    1. I have read the following "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.

    View the Terms and Conditions (PDF).

70. Electronic Signature*

    1. Agree

    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.

72. Full Name (Including middle initial if applicable)*
74. Address*
76. Email*
Leave This Blank:


78. 1. Receive an email copy of this form.
79. Email address

    This field is not part of the form submission.

80. Submit

* indicates a required field