RESIDENTIAL APPLICATION
MN ND
2009 Water Heater Rebate MN and ND Before completing this form, it is important that you read all Water Heater rebate qualifications on the back page of this form. Participants of the ENERGY STAR® New Homes and Home Performance with ENERGY STAR programs are not eligible for Water Heater rebates.
Customer Information
(Customer agrees to be bound by the program rules as shown on back.)
Xcel Energy account number where unit was installed
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Customer name (please print) ___________________________________________________ Daytime Phone (_______)_ ________________________ Mailing address____________________________________ Apt. or Floor #_____ City_ _____________________ State_ _____ ZIP_______________ Installation address_________________________________ Apt. or Floor #_____ City_ _____________________ State_ _____ ZIP_______________ (if different from mailing address) Customer type _
Homeowner
Renter
Landord
Builder
Contractor
Dwelling type
Single family
Duplex
Triplex
Fourplex
Townhome
Commercial
Other
Condominium
Other
Alternate Rebate Recipient (Complete this section only if the rebate should be issued to someone other than the customer named above.) Name _ ____________________________________________________________________ Daytime Phone ( _______ ) ________________________ Address__________________________________________ Apt. or Floor #_____ City_ _____________________ State_ _____ ZIP_______________ Customer signature__________________________________________________________________ Date_ __________________________________ I authorize the above party to receive the rebate check.
Customer signature__________________________________________________________________ Date_ __________________________________ Customer does hereby certify that: 1. the customer, and not Xcel Energy, is solely responsible for the accuracy of the information contained in this application; 2. all installation is complete and operational prior to submitting this application; and 3. all rules of this Xcel Energy program (listed on back) have been followed. Further, the customer acknowledges that participation in this program shall impose no liability on Xcel Energy. In particular, Xcel Energy shall not be liable for the work performed by the customer’s engineer, contractor or vendor, and 4. the information on this form is correct.
Equipment Information
Date of installation ______________________________
Water heater manufacturer __________________________________ Model number (complete) ___________________________________________ Serial number _____________________________________________ Size or Capacity (gallons) _ _________ BTU_ _______ Energy Factor__________ $40 - .62 EF
$60 - .64 EF
$100 - .80 EF Tankless Water Heater
Contractor Information The heating, ventilation and air conditioning (HVAC) contractor or builder signature certifies the Xcel Energy customer whose account number is on this form is aware of the full rebate amount. These signatures also certify that if the rebate check is to be mailed to the HVAC contractor or retailer, the customer is aware of the full rebate amount and has received full credit or has made arrangements with the contractor to negotiate the full amount of the rebate. HVAC contractor name ________________________________________________________ Contact person _ ________________________________ HVAC contractor number ____________________________________________________________________ HVAC contractor address________________________________________ City___________________________ State_ _____ ZIP________________ HVAC water heater contractor signature_________________________________________________ Date_______________ Phone ( _______ )_____________________ I hereby certify that all information is accurate, including claims of efficiency, size and customer information. I have read all the information on the back of this form, and Xcel Energy may verify all the information that I have provided. For Rebate operation use only. Do not write in this area. Approved by:______________________ Date: _ ____________ Rebate amount:___________Date purchased: ___________ Install date:_ ___________ 08-11-210 CRS Mail ID: 677
MN Charge code: 4363
Xcel Energy copy: white Retailer copy: yellow Customer copy: pink
Qualifying Customers Xcel Energy natural gas residential customers in Minnesota and North Dakota are eligible for rebates when buying qualifying, high-efficiency, new natural gas water heaters (reconditioned equipment is not eligible). The program is applicable only for the purchase and installation of qualifying new water heaters sold by participating HVAC contractors or retailers for installation in new or replacement applications where natural gas is supplied by Xcel Energy at Xcel Energy retail rates. Rebates for new home construction must be negotiated between the builder and resident or new home buyer to determine who receives the rebate. Equipment Water Heater Water Heater Tankless Water Heater
Efficiency Rating Rebate .62 EF $40 .64 EF $60 .80 EF $100
Efficiency ratings are determined using the Gas Appliance Manufacturers Association (GAMA) directory, www.gamapower.org. Only equipment listed on GAMA site is eligible for rebate. Participants understand they are not eligible to receive a rebate for an improvement earned under a different Xcel Energy Rebate program. Rebate Details Xcel Energy issues cash rebates in the form of checks, not utility bill credits. Xcel Energy is not responsible if your HVAC contractor provided inaccurate information about the amount and/or conditions of the actual rebate or equipment eligibility. Rebate requests for water heaters within five years of a previous request will not be accepted. Application Details Qualifying equipment must be purchased and installed between January 1, 2009 and December 31, 2009. Customers must apply for this rebate by July 31, 2010. Applications must include complete HVAC contractor or retailer information about water heater information including: size or capacity, make, model number, serial number and efficiency rating. Failure to complete this information will result in a rejection of the application. No phone calls will be accepted to provide verification of this information.
A copy of the dated sales receipt or invoice must accompany complete information on the front of this form. The product invoice must specify all required information. Failure to complete this information will result in a rejection of the application. We reserve the right to conduct random inspections to verify installation of the residential water heater at the address indicated on the front of this form. If we select your application for a random inspection, the rebate application will not be processed until the inspection has been satisfactorily completed. Inspections may be performed after rebate payment at our discretion. Limitations Rebate quantities are limited; installation by a customer of a qualified water heater does not obligate Xcel Energy to pay a rebate. Rebate qualifications and amounts are subject to change any time. Our conservation rebates program may be canceled with 30 days notice. If you are building a new home, you must obtain a sales receipt for the equipment from your builder or retailer. Only one rebate per water heater will be paid. If you have questions while filling out this form, please contact your HVAC contractor or retailer for assistance. Please allow six weeks for your rebate to arrive. Please visit us at xcelenergy.com/homerebates or call 1-800-8954999 to determine whether any program changes have occurred. Send Complete Applications to: Rebate Operations P.O. Box 829 Minneapolis, MN 55440-0829 Please include the items listed below on your application form and purchase receipt. If all of the items are not included the application will be returned to the customer. Your application needs to include: • Xcel Energy Account Number • Xcel Energy HVAC Contractor Number (Provided by your contractor) • Your Signature Your Purchase receipt/invoice needs to include: • Customer name • Installation address • Brand • Model number • Size or capacity • Serial number • Invoice date • Efficiency level
414 Nicollet Mall | Minneapolis, MN 55401 | 1-800-895-4999 | xcelenergy.com © 2008 Xcel Energy Inc. | Xcel Energy is a registered trademark of Xcel Energy Inc. | Northern States Power Company - Minnesota, an Xcel Energy Company
08-11-210
CRS Mail ID: 677
MN Charge code: 4363
Xcel Energy copy: white Retailer copy: yellow Customer copy: pink