Rebate Application

Power Saver Program Saving Energy Together Solar PV Program Rebate Application If you have any questions about this rebate application or any other services provided by our Commercial Rebate, please call 482-5346, email us at [email protected] or visit our website at: www.austinenergy.com CUSTOMER INFORMATION Electric Account Number of Installation Address:

Office Use Only: Please fill out any information that may apply.

Installation Address (Street, etc.):

Zip Code:

File #

Customer/Business Name:

SBQ:

Day Phone # Alternative Phone #

Contact:

E-mail address:

Facility Name:

Installation Date:

Mailing Address (if different from above):

Permit # If Applies:

City:

Zip Code:

State:

Tax ID #

VENDOR / INSTALLER INFORMATION Vendor’s Name:

Day Phone #

Vendor’s Representative:

Alt. Phone #

Vendor’s Address:

City:

Zip Code:

State:

System Installation Residential †

Contractor Price Quote:

Structure:

Multi-Family † New

Estimated kWh Savings/Yr.

Locally made:

†

Methodology Used:

Yes † $ ____________________

Commercial † Existing †

No

PV Moduel Mfg*

Inverter Mfg* Qty.

Model # STC Rating (watts)

†

Model #

Array Orientation:

Power Rating

Efficiency %

* Please list additional models/inverters on reverse side of this application. Number of Modules

x

STC Rating (watts)

x

Inverter Eff. % =

System Rating (W)

x

Rebate Level =

Rebate Amount

I certify that the above listed solar PV equipment meets the program guidelines and requirements of the Solar PV Rebate and that all documentation submitted is true and correct t to the best of my knowledge. I further certify that the photovoltaic system will be installed in compliance with Austin Energy's technical requriements for distributed generation interconnection (for facilities under 20 kW). Vendor/ Contractor's Signature: Date: ADDITIONAL CUSTOMER AGREEMENT CLAUSE As a qualified Austin Energy (AE) customer, I understand that the rebate I am applying for will under no circumstances exceed the maximum allowed under the current Solar PV Rebate guidelines. I acknowledge that I am responsible for maintaining the operational efficiency of all qualifying measures for a period of no less than five (5) years from the dat of this agreement. I agree to allow an AE Representative to inspect the referenced facility for compliance with this requirement for the duration of this agreement. In consideratio of this rebate, I assign all rights to any and all environmental attributes and or credits, including any renewable energy credits, carbon offset credits, or similar environmental credits derived from the renewable energy production associated with this rebate to AE for AE's use as it may choose. A prorated portion of the rebate, calculated by reducing the rebate paid by 20% per year for each of the five years following final inspection and approval (first 20% reduction to occur on the first anniversary date of rebate payment), shall b come due and payable to AE if I fail to ensure AE that the rebated equipment is properly maintained and operated at an AE metered address.

Customer Signature:

Date:

AUSTIN ENERGY EMPLOYEE Comments: Date of Pre-Inspection:

† Qualified

A.E. Representative Signature:

† Non-Qualified

Date of Final Inspection:

† Pass

† Fail

A.E. Representative Signature:

Rev. 3/24/08