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Count on ME Rebate Claim Form

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Upload proof of purchase / invoice from solar installer. Include module serial numbers in uploaded proof of purchase or enter serial numbers below.

If not listed in uploaded proof of purchase, list all module serial numbers installed:

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By submitting, you agree to the terms: For good and valuable consideration, the receipt of which is acknowledged, I hereby grant Mitsubishi Electric US, Inc., its parents, subsidiaries, affiliates, agents, representatives, and all persons or corporations acting with its permission or under its direction including but not limited to consultants, contractors, advertising agencies and representatives, fulfillment agencies, dealers, distributors, resellers, integrators, and other affiliated agencies (the “Released Parties”), permission to interview me, photograph me or my property, to have others photograph me or my property, and to publish, exhibit, exploit, reproduce, edit, distribute, modify, display, or otherwise use or re-use any such quote, interview, photograph and my name, image, likeness, and biographical material (collectively, the “Content”) in any media for any lawful purpose, including but not limited to advertising, promotion, and marketing of the Released Parties’ products and services. I hereby grant the Released Parties permission to display the Content on the Internet or in any other medium and to use it in whole or in part, individually or in conjunction with other photographs, videos, images, or material. I hereby waive any right to royalties or other compensation arising from or related to the use of the Content, and agree that I will make no claim for any reason to any of the Released Parties in connection with use of the Content. I hereby waive any right I may have to inspect and approve any materials containing the Content or the use to which the Content may be applied. I further release the Released Parties and each of their respective officers, directors, employees, parents, subsidiaries, and affiliates from any and all claims, demands, and liabilities whatsoever, whether known or unknown, foreseen or unforeseen, arising out of or in connection with use of the Content. I agree that this Permission and Release is absolute, irrevocable, worldwide, and perpetual. The laws of California shall apply to this Permission and Release, regardless of its conflict of laws principles. I am an adult (18 years of age or older), with full legal capacity to execute this Permission and Release, which I have read and understood and which I am signing intending to be legally bound.

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