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I want Smart
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Clean & Check
$50 Consumer Rebate


Based upon signature of the SMART Member performing the work, the homeowner or business owner and the contractor, I Want SMART will make payment to the homeowner or business owner pursuant to its Rebate Program. The SMART Member, homeowner or business owner, and contractor certify that the information printed here is true.

___________________________   _____________   ________________________
Member Print Name                           IA Number           Member Signature

_______________________________________   _____________
Homeowner/Business Owner Signature           Date

_______________________________________
Contractor Name

Please return completed form to:

I Want SMART Rebate Processing, 205 Alexandra Way, Carol Stream IL. 60188