RESIDENTIAL AND COMMERCIAL APPLICATION
2009 HEATING SYSTEM REBATE
CO
Before completing this form, it is important that you read all Heating System Rebate Qualifications on the back page of this form. Participants of the ENERGY STAR New Homes program are not eligible for Heating rebates. CUSTOMER INFORMATION (Customer agrees to be bound by the program rules as shown on back.) –
Xcel Energy Gas Account number
–
Customer name (PRINT)_________________________________________________ Daytime phone ( ________ ) _____________________________ (As shown on your utility bill)
Mailing address (PRINT)_ ___________________________________________ City_ _________________________ State_ ______ ZIP_ _________ Installation address (PRINT)_ ________________________________________ City_ _________________________ State_ ______ ZIP_ _________ (If different from mailing address)
Apartment or floor number_ ____________________________________________ Customer type:
Homeowner
Renter
Landlord
Builder
Contractor
Commercial
Other
Dwelling type:
Single family
Duplex
Triplex
Fourplex
Town home
Condominium
Small Business/Commercial Site
Other
Alternate Rebate Recipient: Complete this section only if the rebate should be issued to someone other than the customer named above. Name (PRINT)_ _____________________________________________________ Daytime phone ( ________ )_ ____________________________ Address_______________________________________________________ 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. installation is complete and operational prior to submitting rebate; 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; 4. I verify the information on this form is correct.
Installation Date:____________
EQUIPMENT information
Manufacturer (PRINT)__________________________________________________ *Model # (complete)____________________________________ Serial Number ____________________________________________ Size or Capacity (btu)________________ Efficiency (AFUE or CAE)___________ Rebate Amount $______________________________ Rebate Amount (Effective starting 1/1/09)
1. Does the new furnace have a variable speed fan? 2. Did you also replace your central air conditioner? 3. Did Xcel Energy rebate influence your buying decision?
$80 — 92 % + AFUE Furnace (Residential or CO Commercial Gas Customer Only)
Yes Yes Yes
No No No
$120 — 84 % + AFUE Boiler (Residential Gas Customer Only)
$120 — 94 % + AFUE Furnace (Residential or CO Commercial Gas Customer Only) *List model number that GAMA uses to represent equipment installed at this address.
Retailer 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. This signature also certifies that if the rebate check is to be mailed to the HVAC contractor or builder, the customer is aware of the full rebate amount and has received full credit or has made arrangements with the builder to negotiate the full amount of the rebate.
HVAC Contractor Name (PRINT)_ _________________________________________ Contact Person (PRINT)__________________________________ HVAC Contractor Number______________________________________________ Is the installer NATE certified?
Yes
No
Address________________________________________________________ City_ _________________________ State_ ______ ZIP_ _________ 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.
HVAC Contractor Signature_ ___________________________ Date____________ Phone number ( ________ ) _____________________ FOR REBATE OPERATIONS USE ONLY. DO NOT WRITE IN THIS AREA. ENTERED BY:_______________ 09-03-521
CSS MAIL ID: 1963
DATE:____________________
CO CHARGE CODE: 9774
REBATE AMOUNT:___________
DATE PURCHASED:___________
XCEL ENERGY COPY: WHITE
INSTALLED DATE:____________
RETAILER COPY: YELLOW
CUSTOMER COPY: PINK
2009 COLORADO HEATING SYSTEM REBATE QUALIFICATIONS
Qualifying Customers Xcel Energy residential natural gas customers in Colorado are eligible for rebates when buying qualifying, natural gas high-efficiency, new furnaces, boilers or combination boiler & water heaters (reconditioned equipment is not eligible). Xcel Energy commercial natural gas customers in Colorado are eligible for furnace rebates only. The program is applicable only for the purchase of qualifying new natural gas furnaces, boilers, or combination boiler & water heaters 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.
If you have questions while filling out this form, please contact your HVAC contractor for assistance. Please allow six weeks for your rebate to arrive. If you are applying for a heating system and an air conditioning rebate, please note the rebate checks will be sent separately. Rebate qualifications and amounts are subject to change and the program may terminate at any time. Please visit us at xcelenergy.com/homerebates or call 1-800-895-4999 to determine whether any program changes have occurred. Send Complete Applications to: Xcel Energy Rebate Operations P.O. Box 829 Minneapolis, MN 55440-0829
EQUIPMENT
AFUE/CAE
REBATE
Furnace
92% + AFUE
$80
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:
Furnace
94% + AFUE
$120
Boiler
84% + AFUE
$120
Efficiency ratings are determined using the Gas Appliance Manufacturers Association (GAMA) directory. Xcel Energy does not accept manufacturer specification sheets or documents to verify equipment. Rebate Details These rebate amounts are valid only for equipment purchased and installed between January 1, 2009, and December 31, 2009. 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.
Xcel Energy Account Number Your Signature Your Purchase receipt/invoice needs to include: C ustomer name Installation address Model number Serial number Invoice date
Application Details Customers must apply for 2009 rebates by July 31, 2010. Applications must include complete HVAC contractor information and furnace, boiler or combination boiler & water heater information including: size or capacity, make, model number, serial number and efficiency rating. Failure to fully complete this information will result in a rejection of the application. No phone calls will be accepted to provide verification of this information. An application that is denied due to equipment ineligibility will not be accepted with changed model numbers. A copy of the dated sales receipt or invoice must accompany complete information on the front of this form. Failure to fully 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 heating system 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. Rebate qualifications and amounts are subject to change any time. Our conservation rebates program may be canceled with 30 days notice. Participants understand they are not eligible to receive a rebate for an improvement earned under another Xcel Energy program. If you are building a new home, you must obtain a sales receipt for the equipment from your builder. Only one rebate per furnace, boiler or combination boiler & water heater will be paid.
Customer Call Center 1-800-895-4999 Business Solutions Center 1-800-481-4700 xcelenergy.com © 2009 Xcel Energy Inc. Xcel Energy is a registered trademark of Xcel Energy Inc. Public Service Company of Colorado, an Xcel Energy Company
09-03-521
4/09
CRS#1963