Ottawa Wood Burning Changeout Application Form

Primary reason for buying appliance * Old appliance was worn outEfficiency - use less woodEmissions - reduce air pollutionEnvironmental concernsAesthetics - new look for hearthConvenience - easier to useRebateOther

SUPPORTING DOCUMENTS

Please provide the following supporting documents in any of the following ways:
• Scanning the original document and uploading to this form
• Taking a high-resolution digital picture of the original document and uploading to this form
• Checking the box indicating you will mail a copy of the document to the HPBA Canada office

Sent via email or mailMy retailer attests my old appliance was properly disposed of/recycled

Ottawa Wood Burning Changeout Program Application Form