Insulation Incentive
Application for Residential Customers
Brought to you by:
[Enter you utility’s information here]
READY TO SAVE MONEY AND REDUCE ENERGY CONSUMPTION?
HERE’S HOW:
Please review this review this application or contact [MUNICIPAL UTILITY] to learn about the program details and what rebates are available.
Then select weatherization materials based on the conditions shown in this brochure. After purchasing and installing qualifying equipment, please follow these simple instructions:
- Weatherization materials must be installed in a home where the primary heating fuel is supplied by [MUNICIPAL UTILITY].
- After the weatherization materials are installed, complete this application, including signatures.
- Attach a sales receipt from the dealer or installer of the weatherization materials showing total product and installation cost. Equipment must be purchased and installed between January 1, 2011 and December 31, 20011 to qualify for the 2011 incentive program.
Please allow 6-8 weeks for payment. Payment processing may take longer if information is missing on the application.
Customer Information (Please Print)Name of Homeowner / Phone / Installation Date
Mailing Address / City / State / ZIP Code
Installation Address / City / State / ZIP Code
Utility Account Number (Found on Utility Bill)
Email Address (By providing your email address, you are granting The Utility permission to send emails regarding this project or updates on our incentive programs.)
Age of Home or Year Built / Heating Source
Natural Gas Electric Resistance Heat Pump / Building Use
Single Family Apartment/Condo
Customer Agreement:
My signature indicates consent to and agreement with all program terms and conditions. It certifies that all information in this application is correct and that all of the listed new equipment has been purchased, installed, and is operating at the indicated location. I understand that my utility company reserves the right to inspect and verify installation before and after issuing payment.
Customer Signature / Printed Name / Date
Installer / Contractor Information
(Insulation must be installed by a qualified installer unless an energy audit has identified the need for added insulation.)
Name of Installing Contractor / Mailing Address / City / State / Zip
Phone / Email Address (By providing your email address, you are granting The Utility permission to send emails regarding this project or updates on our incentive programs.)
Residential Weatherization Information
Installation Type / Recommended
(not required) R-Value / Insulation Type (cellulose, fiberglass,etc.) / Sq. Ft. Installed / R-Value / Total
Installed Cost / Incentive =
70% of Cost or Project Max.
of $750
Pre / Post
Attic Insulation / R-49 / $
Mass Wall (concrete or masonry) / R-19 / $
Wood Frame Wall
The +R5 is insulated sheathing / R-20 cavityor
R13 cavity + R5ci
Floor over Unheated Area / R-30 / $
Basement Wall Interior / R-15 cior
R-19 cavity / $
Crawl Space Wall / R-10 cior
R13 cavity / $
Total: / $
Maximum Project Incentive = $750. If Total is greater than $750, enter Maximum Incentive here: / $
PLEASE ATTACH THE FOLLOWING REQUIRED DOCUMENTS:
1)Invoice clearly showing proof of purchase including type of insulation, details of work performed, date of installation, installation address, and total project cost.
Utility Use Only / Date Received / Incentive Approved Yes No / Date Approved / Amount: $
ELIGIBILITY:
•These incentives are offered by [MUNICIPAL UTILITY]. Please contact [MUNICIPAL UTILITY] with questions regarding the program.
•Installation must be done by a qualified installer unless an energy audit of the home has identified the need for added insulation. Attach a copy of the energy audit if the project is self-installed.
•Residential customers who purchase their primary heating fuel from The Utility are eligible to participate in Weatherization Incentive Program.
•Only single family homes or multifamily buildings of four units or less are eligible.
•Homes built after December 31, 2000 are not eligible.
•Customers may not receive more than one incentive for a weatherization project per year.
•Program excludes new residential construction, new residential additions, garages, sheds, and workshops.
INCENTIVE LIMIT:
•Eligible customers may purchase and install qualifying products and receive a weatherization incentive of up to $750 per year.
•Total incentive will not exceed 70 percent of the project cost, including installation, but shall not exceed 70% of the total project cost.
PROGRAM TERMS AND CONDITIONS
•If self-installed, attach a copy of the energy audit advising installation of additional insulation.
•This rebate program is being offered by [MUNICIPAL UTILITY] which will be referred to as “The Utility” throughout this document.
•Limit one weatherization incentive per dwelling per year. Applicant must be a current customer of The Utility, and The Utility must provide the primary heating fuel to the dwelling.
•The Utility does not guarantee that the installation and operation of energy efficiency equipment will result in reduced usage or demand or in cost savings. The Utility makes no warranty of merchantability or fitness for a particular purpose. In no event shall The Utility be liable for any incidental or consequential damages or injuries resulting from defective equipment or installation.
•The rebates are offered on a first come, first served basis. The Utility reserves the right to cancel or change these programs at any time. The Utility’s acceptance of this application does not guarantee payment of the incentive. Prior to any payment of incentive, They Utility reserves the right to verify sales transactions.
•The Utility will not be responsible for any tax liability that may be imposed on the customer as a result of the payment of rebates.
•The Utility does not endorse any particular manufacturer, product, system design, claim or retailer in promoting this program.
Thank You for participating in the eco@home residential insulation program. / Residential Weatherization Page 11/24/11