New Solar Rebate Form Smallerkw_2008

City of Colton – Electric Utility Department Photovoltaic Incentive Program Rebate Application Form Systems Smaller Than 30 kW

Applicant Information: Customer Name: _____________________________ Utility Account Number: ______________ Contact Person: ______________________________ Phone Number: _____________________ Mailing Address: ________________________________________________________________ Residential Customer: _______ Business Customer: _______ Nontaxable Customer: ________ Installation Address: _____________________________________________________________

Installation Information: Company Name: ________________________________________________________________ DBA Name: ____________________________________________________________________ Contact Person: ______________________________ Phone Number: _____________________ Contractor License Type: ________________________ License Number: ___________________ Mailing Address: ________________________________________________________________ City: ____________________________ State: __________________ Zip: __________________ Estimated Watt Production: ______________________ Watts X $4.00 = $__________________ Estimated System Cost: _______________________ Estimated Cost X 50% =$_______________ Estimated Rebate Amount: _______________________________________________________ (Estimated Rebate Amount is determined by comparing the Watt production calculation and the 50% calculation of the estimated cost. Whichever value is less will determine the estimated rebate amount.

Rebate Payment Consent: Rebate Payee: __________________________________________________________________ Make Check Payable to: __________________________________________________________ Mailing Address: ________________________________________________________________ City: ____________________________ State: __________________ Zip: __________________ Social Security Number: _____________________ Federal Tax ID Number: _________________ (If payable to customer)

Photovoltaic Rebate Form

(If payable to Installer)

Page 1 of 2

*Rebate check will be issued only after all of the work has been completed, after the installation has been reviewed and authorized with a post installation inspection by the City of Colton Electric Utility representative, and once itemized invoices with a copy of the final invoice stating the system and all work has been paid in full, with no additional balance, has been received.

Signatures: The undersigned warrants, certifies and represents that the information provided in this form is true and correct to the best of my knowledge and that the installation will meet all of the City Colton Utility terms and conditions.

Customer Name (Print): __________________________________________________________ Signature: _______________________________________ Date: _________________________ Installer Name (Print): ___________________________________________________________ Signature: _______________________________________ Date: _________________________ The above named customer agrees to abide by the rules and regulations of the City of Colton Electric Utility Department’s PV Incentive Rebate Program and agrees to allow in The City of Colton Electric Utility Department to claim the renewable energy production credits produced by the renewable energy system that has received incentive funding from the City of Colton Electric Utility Department.

Authorization: __________________________________ (Customer Name) has been granted a reservation of $____________ for a _______________kW solar photovoltaic (System). The rebate shall be paid to ______________________ (rebate payee), as agreed upon between the customer and the installer (as noted above). The reservation will expire on ________________ (90 days from the date of application approval). The system is being installed at ________________________ ____________________________________________________________ (installation address). Utility Representative Name: ______________________________________________________ Utility Representative Title: _______________________________________________________ Signature: _______________________________________ Date: _________________________

Photovoltaic Rebate Form

Page 2 of 2