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Residential Energy Efficiency Home Improvements

Rebate Application
CUSTOMER INFORMATION
Name (As it appears on Utility Bill) Colton Electric Account # (Required)

1 Address

(where measure is installed)

Mailing Address (if different from street address) Phone Number

PURCHASE INFORMATION

In order to receive the Rebate, ALL information MUST be completed for each qualifying item
SUPPORTING DOCUMENTATION Proof of Purchase / Sales Receipt

Copy of Energy Guide Label showing item is ENERGY STAR approved


* on required qualified measures

CUSTOMER: PLEASE SIGN


By signing below, I certify that I have read, understand and agree to abide by the terms and conditions herein and that the information on this rebate form and on the attached supporting documents is accurate and complete. In addition, I certify that the installation of all energy efficient upgrades and/or equipment complies with applicable permitting requirements and that any contractor used to perform the work holds the appropriate license. AUTHORIZED SIGNATURE:_______________________________ DATE: ___________

MAIL INSTRUCTIONS MAIL APPLICATION WITH SUPPORTING DOCUMENTS TO:

COLTON ELECTRIC DEPARTMENT 650 N. LA CADENA DRIVE COLTON, CA 92324 If you have any questions, contact Energy Services at (909) 514-4214
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Home Improvement Product


OCCUPANCY SENSORS
(Limit 8)

Rebate Amount

Home Improvement Product Details


_____________ ________________
Model #

$15

Manufacturer

________________
Purchase Date

___________________
Quantity

POOL PUMP
Only Two Speed and Variable Speed Pool Pumps are Eligible

_____________

________________
Model #

$200

Manufacturer

________________
Purchase Date

SOLAR ATTIC FAN


All Solar Attic Fans are Eligible

_____________

________________
Model #

$200

Manufacturer

________________
Purchase Date

WHOLEHOUSE FAN
All Whole House Fans are Eligible

_____________

________________
Model #

$100

Manufacturer

________________
Purchase Date

____________________
Total Sq. Ft. of Home

ROOM A/C
Window or Wall Mounted *Must be Energy Star

_____________

________________
Model #

$100

Manufacturer

________________
Purchase Date

___________________
EE Rating

CEILING FAN
(Limit 4) *Must be Energy Star

_____________

________________
Model #

$15

Manufacturer

________________
Purchase Date

___________________
Quantity

TERMS AND CONDITIONS


ELIGIBILITY

I understand that I must be a Colton Electric Utility customer and I must have an active Colton Electric Account. If I am a tenant, I am responsible for obtaining the property owners permission to install the measure for which I am applying for. My signature on this application indicates that I have obtained this permission I will provide, if requested, a Colton Electric Utility representative reasonable access to my residence to verify the installation of measures. I understand that a rebate will not be paid if I refuse the request for verification. Rebates are on a first come first serve basis, the program will end when all approved funding has been spent.

APPLICATION

This signed dated application, copies of proof of purchase and other required supporting documentation must be sent to Colton Electric Utility postmarked no later than four months from the date of purchase. I am responsible for filling out the application completely, truthfully and accurately. I understand that Colton Electric Utility is not responsible for items lost or destroyed in the mail/transit.

PAYMENT

Payment of the rebate is conditional that all correct supporting documentation be submitted with application. We will mail the rebate check for qualifying item(s) within six weeks of receiving completed application.

FOR COLTON ELECTRIC UTILITY USE ONLY Date Application was Received: _______________ Reviewed By: _____________________________ Total Rebate Amount: _____________________