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(Effective March 1, 2012)

Please print in all spaces Consumer of Record 1 _____________________________________________________________________________ Consumer of Record 2 _____________________________________________________________________________
(only required if joint account or if another person is authorized on the account)

Mailing Address Daytime Phone Account Number



Cell Phone _______________ Email _______________________ Service Location # _________________

(seven digit number)

(nine digit number)

County ____________

Solar Thermal Facility: Installation Location ____________________________________________________________________________ ______________________________________________________________________

Brief System Description

________________________________________________________________________________________________ _______________
(Number of Panels)

(Number of Persons in Household)

Incentive Amount (Cannot Exceed $6,000) X $1,500 per panel =

(Number of Panels) (Estimated Incentive)

Please note: The incentive listed above is subject to change and/or discontinuation at any time without notice. Funding is limited. Applications will be accepted on a first come, first served basis. We reserve the right to inspect the installation premises or request additional information/documentation prior to any payment of incentive. Holy Cross Energy is not liable for any act or omission of any party, consumer or contractor whatsoever. If Applicant makes any misrepresentation in the Application or fails to abide by each and every term and condition of the WE CARE rebate program in effect from time to time, then after notice by HCE to Applicant of such violation the Applicant shall forthwith pay to HCE all of such rebate to HCE. If Applicant fails to pay such rebate to HCE within ten days after such notice, then Applicant shall pay in addition to such amount all of HCEs cost of collection of such amount including without limitation all of HCEs attorney fees. All unpaid amounts due by Applicant to HCE shall bear interest at the rate of eighteen percent per annum from the due date until paid; and such interest shall be compounded annually. HCE may at its sole election at any time offset or equitably recoup any amount due from Applicant from any amount that HCE has due or that may become due from HCE to Applicant. HCE may at its sole election add any amount due by Applicant to any electric service bill of HCE to Applicant; and HCE shall have all of its rights for Applicants failure to pay such electric service bill including without limitation termination of electric service. Page 1 of 2


(Effective March 1, 2012)

The consumer(s) of record must submit a complete and fully executed Solar Thermal Pre-Application form to Holy Cross Energy after execution of the third party contract associated with the installation of the consumers solar thermal system for existing domestic hot water use only involving electric water heaters. Baseboard or radiant floor heating is not eligible. This above incentive does not apply to: 1) New home construction; 2) Existing water heater fuel resources including fuel oil, natural gas, or propane; and 3) Any project that requires compliance with REMP or ECO-BUILD mandates. The incentive applies up to a four (4) panel system with the maximum allowable incentive capped at $6,000. Payments will not exceed 50% of the actual installed cost. The solar thermal system must be completed and inspected by the authorized Holy Cross Energy personnel within one hundred twenty (120) days of the date the pre-application form is received by Holy Cross Energy. Traditionally, the applicable incentive payment is made payable to the consumer(s) of record; however, such consumer(s) of record have the option to assign the incentive payment (in whole) to the company responsible for the installation of the solar thermal system associated with this application. As evidenced by my / our initial(s) below, Consumer of Record 1 Consumer of Record 2

we hereby direct Holy Cross Energy to make the applicable incentive payment to: Company: Mailing Address:

I/we have read, understand and agree to all terms, conditions and requirements herein as established by this WE CARE Program Solar Thermal Application and acknowledge the 120 day deadline for rebate eligibility. Consumer of Record 1 Signature _________________________________________________ Date ________________ Consumer of Record 2 Signature _________________________________________________ Date ________________
Please return your completed Solar Thermal Application along with any supporting documentation to: Holy Cross Energy, Member Services, P.O. Box 2150, Glenwood Springs, CO 81602-2150.

HCE USE ONLY Date Received: __________ Approved By: __________ Application: STS # ________________ Page 2 of 2
M:\WORD\MS&M\WE CARE Program\Applications\Solar Thermal (03.01.12).docx M:\Adobe PDF Documents\WE CARE Program\Applications (March 2012)\Solar Thermal (03.01.12).pdf