Get Started: 1. Verify Customer and Product Eligibility Before Installing: • Read complete list of requirements on Pages 3-4 • View a list of qualifying products online 2. Collect Nicor Gas Account Number and Contractor Invoice 3. Complete this application in full, or apply online at NicorGasRebates.com/home Read the complete list of requirements on Pages 3 and 4 to ensure that your installation is eligible for Program rebates. If you meet the requirements, please complete Steps 2 and 3 (Pages 1 and 2) using the tips and guidance provided on the left, and mail all required documentation to the address listed in the bottom left corner. Step 2: Enter Your Information and Sign Below Step 1: Verify Eligibility Page 1 of 4 NOTE: Incentives are taxable and if greater than $600 in a calendar year will be reported to the IRS unless you are exempt. If you have exceeded a total of $600 in rebates, a W-9 form will be requested if applicable. * Payee: The Program allows the check to be made out to any one of the following: Account Holder, Contractor or Landlord. Please review all requirements listed on Page 4. If you are the Account Holder and wish the rebate check to be made out to you, please complete all of the required fields in the rebate application, provide the required supporting documentation listed on Pages 3 and 4 of this rebate application, and have the Nicor Gas account holder sign on Page 1 as the “Applicant”. The check may also be made out to the Landlord (who is not the account holder) or the installing Contractor (offering an Instant Discount). Please review all requirements outlined on Page 4 for applications submitted by a Landlord or Contractor. The Nicor Gas account holder must sign the applicable Customer Release Form if the check is being made payable to the Landlord or Contractor. Thank you for your interest in the Nicor Gas Energy Efficiency Program! Please follow the steps outlined below to ensure that your application is eligible for submission. Make a copy of your completed application and supporting documentation to retain for your records. 06012012ResApplication 2011 - 2014 Home Energy Efficiency Rebate Program Application The Nicor Gas Energy Efficiency Program is a multi-year program funded by Nicor Gas ratepayers in compliance with state law through a small charge identified on customer bills as “Energy Program.” Account Holder Information Nicor Gas Account Number Prefix (Mr., Mrs., Ms.) First Name Last Name Installation Information Installation Address City State Zip Code Application Contact Information Contact First Name Contact Last Name Contact Email Contact Phone Contractor Information Contractor Business Name Phone Email Address City State Zip Code Mailing Address for Rebate Check Make Check Payable To* Mailing Address City State Zip Code q Account Holder q Contractor q Landlord I certify that the participant has not received/will not receive a rebate for the same product or equipment from more than one Illinois investor owned utility or third-party energy efficiency program offering rebates or financing funded with ratepayer funds. I certify that the energy-efficient product or service was paid for as reflected on the receipt and described in this rebate application. I certify that all information is true and correct, and that I have met all Program requirements as outlined in the General Program Qualifications section. I understand and agree to the terms and requirements for which I am submitting this rebate application, as outlined on Pages 1 through 4. This is q an existing home q new construction Applicant Signature Print Applicant Name Date Promo Code (if applicable) Ready to Submit? n Page 1 is complete with the Account Holder’s signature n Page 2 is complete with all product/equipment information n Contractor Invoice is attached and contains all requirements: - Equipment Make, Model & Serial Number - Total Installed Cost (itemized by qualifying equipment) - Installation & Purchase Dates (if different) - Payment Terms, Balance Due of Zero, or Paid in Full Stamp - Professional Contractor Information (if applicable) - Any rebate-specific invoice requirements listed on Page 3 Submit your completed application and invoice: Nicor Gas Energy Efficiency Program 3800 Watt Avenue, Suite 105 Sacramento, CA 95821-2672 Need help? Contact us at 877.886.4239 Monday through Friday 7:00 a.m. – 7:00 p.m.
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Transcript
Get Started:
1. Verify Customer and Product Eligibility Before Installing:• ReadcompletelistofrequirementsonPages3-4
• Viewalistofqualifyingproductsonline
2. Collect Nicor Gas Account Number and Contractor Invoice
3. Complete this application in full, or apply online at NicorGasRebates.com/home
ReadthecompletelistofrequirementsonPages3and4toensurethatyourinstallationiseligibleforProgramrebates. Ifyoumeettherequirements,pleasecomplete Steps 2 and 3 (Pages 1 and 2) using the tips and guidance provided on the left, and mail all required documentation to the address listed in the bottom left corner.
Step 2: Enter Your Information and Sign Below
Step 1: Verify Eligibility
Page 1 of 4
NOTE: Incentives are taxable and if greater than $600 in a calendar year will be reported to the IRS unless you are exempt. If you have exceeded a total of $600 in rebates, a W-9 form will be requested if applicable.
2011 - 2014Home Energy Efficiency Rebate Program Application
The Nicor Gas Energy Efficiency Program is a multi-year program funded by Nicor Gas ratepayers in compliance with state law through a small charge identified on customer bills as “Energy Program.”
Account Holder Information
Nicor Gas Account Number Prefix (Mr., Mrs., Ms.) First Name Last Name
Installation Information
Installation Address City State Zip Code
Application Contact Information
Contact First Name Contact Last Name Contact Email Contact Phone
Contractor Information
Contractor Business Name Phone Email
Address City State Zip Code
Mailing Address for Rebate Check
Make Check Payable To* Mailing Address City State Zip Code
• CompleteSystemReplacementrebatesareavailabletocurrentresidentialdeliverycustomersofboth Nicor Gas and ComEd(CommonwealthEdison).
• CompleteallfieldsinthesecondtableifyouareapplyingforaCompleteSystemReplacementRebate.Do not enter furnace information in the first table.
• Include the AHRI Certified Reference Number-Askyourinstallingcontractorforassistance,orvisitNicorGasRebates.com/csr.
Complete System Replacement Rebates:
Rebate-Specific Requirements:
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New rebate offerings available for qualifying purchases and installations completed November 19, 2012 through May 31, 2013. Refer to the last page of this application for more information.
Storage Water HeatersEnergyFactor>0.67 NewequipmentmustmeetENERGYSTARstandardswithanEnergyFactor>0.67.Instantaneous(tankless)waterheatersarenoteligible.
Choose the rebate that’s right for your home today. Visit NicorGasRebates.com/home or call 877.886.4239 to learn more.
Now there are even more ways to save money and energy with the Nicor Gas Energy Efficiency Rebate Program! Enjoy the benefits of natural gas efficiency in your home. You may experience increased comfort, lower utility bills and the peace of mind knowing you are using less energy.
LOOK FOR THE BEST VALUE BADGEThe Home Energy Efficiency Rebate Program now offers new ways to save energy in your home—including more efficient products and value packages. Look for this badge on the rebate information page at NicorGasRebates.com/home to find offers that can bring you the best rebate, energy savings and utility bill savings!
For complete program rules, dates, and eligibility, visit NicorGasRebates.com/home. Offers are limited and subject to change. The Nicor Gas Energy Efficiency Program is a multi-year program funded by Nicor Gas ratepayers in compliance with state law through a small charge identified on bills as “Energy Program.”
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EQUIPMENT TYPE EFFICIENCY REQUIREMENT REBATE AMOUNT