Existing Home Rebate Form

DATE:

2009 EXISTING HOME REBATE

NAME:

SSN/TAX ID:

ADDRESS: CITY:

STATE

HOME PHONE:

WORK PHONE:

ZIP

Acct #: Existing Home Rebates for homes completed before January 1, 2009: All Central Georgia EMC rebates are subject to change without notice. Rebate program will end on December 31, 2009. Prior to receiving Heat Pump Rebate, all applicants shall consent to having a Load Management Switch installed on all applicable heat pumps and agree to have the Load Management Switch for as long as Central Georgia EMC maintains a Load Management program. Receipts must be included with all rebate requests. Load Management Switch installations are performed by Central Georgia EMC. Installed Compact Fluorescent Lights (CFL) -$1.00 per light, 12 max per home # of CFLs purchased Maker: Model:

Rebate $:

Upgrade to a Programmable Thermostat -1/2 the cost up to $25, 2 max per home # purchased Maker: Model:

Rebate $:

Replace Gas to Electric Heat Pump Rebate-$200 for 13 SEER(R410A) or above Rebate $: SEER Maker: HSPF: Model: Unit Installed by: Load Management Switch Installed Replace Gas to Electric Marathon Water Heater Rebate-$200 for 50 gal. or above Rebate $: WH Size Unit Installed by: Upgrade Attic Insulation to R-39 or Greater -1/2 the cost up to $200 max Job by: H/O or Contractor: Certificate: Yes No

Rebate $:

Total Rebate $: I, the undersigned, Homeowner, understand the requirements set forth in each rebate program must be met in order to qualify for rebate payment. Signature:

Date:

For CGEMC USE ONLY Approved by CGEMC Rep: Total Rebate $:

Check #

V#

Date Paid:

923 S. Mulberry Street Jackson, GA 30233 770-775-7857 White-Bookkeeping

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