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Moreno Valley Electric Utility (MVU)

Residential Solar Electric Rebate Program


Application for 2012/2013

Customer
Applicant (Customer Name on MVU Utility Account)

Customer Account Number

Installation Address (Street, City, ZIP)

Billing Address (Street, City, ZIP)


________________________________________________________________
Applicant Phone Number/ Applicant email address
_________________________________________________

Contractor/Installer
Installer name

Contractor name
_______________________________________________________________
Business Address
_______________________________________________________________
Phone Number/contact email address

State Contractors License Class and Number, Expiration Date


________________________________________________________________
City of Moreno Valley Business License Number, Expiration Date
________________________________________________________________

System (equipment must be on CEC-approved list)


Modules (Manufacturer, Model Number, PTC Power Rating, Quantity)

Inverters (Manufacturer, Model Number, CEC Efficiency, Quantity)

Design Factor for Site


Orientation (south, west, southwest)
_______________________
Tilt (5 to 55 degrees)
_______________________
Azimuth
_______________________
Shade Analysis
_______________________

System Output in AC Watts


System Output in AC Watts (includes total module output watts x inverter
efficiency x design factor), per CSI EPBB Calculator :
__________________________

Total Rebate Amount Requested ($2.25 x System Output in


Watts):
____________________________

Certification
Each undersigned certifies that
the information in this form is true and correct to the best of my knowledge
the solar PV system is intended to offset part or all of the customers
electrical needs at the site of the installation
the site is within the service territory of the Moreno Valley Electric Utility
In addition, each undersigned understands and agree that the choice of
improvements, the selection of contractors, the purchase of items and
acceptance of materials used and work performed and the payments thereof is
the sole responsibility of the owner. Moreno Valley Electric Utility does not
endorse, recommend or make any representations as to specific brands,
products, contractors or dealers; nor does it guarantee material or workmanship.
Further, undersigned agree to indemnify and hold harmless the City of Moreno
Valley, its officers, employees and agents from and damages related to the use
or installation of PV-related equipment.

Customer Name
_______________________________________________________________
Signature of Customer
_______________________________________________________________
Date

Contractor Name
_____________________________________________________________
Name and title of signer
___________________________________________________________
Signature
___________________________________________________________
Date
For Office Use Only
Date Received ______
Project Number______
Rebate Amount ______
Rebate Check Requested by __________ Date _______
Rebate Check Approved by ___________ Date _______