Residential Home Energy Efficiency Rebate Application 744 West 20th St.

PO Box 2288, Merced, CA 95340 Phone: 209-722-5761 Fax: 209-726-7010 Page 1 of 4

Merced Irrigation District

Residential Home Energy Efficiency Rebate Application and Instructions
Customer information: Customer Account #: Customer Name: Customer Address: City: How to Apply: 1. Read the Terms and Conditions The terms and conditions are found in this Home Energy Efficiency Rebate Form. Applications will be accepted on a first-come, first-served basis. Please call MID at 209-722-5761 to determine if rebate forms are still being accepted and funds are still available before submitting your application. This program shall at all times be subject to change or termination without prior notice. 2. Complete Rebate Form and mail with proof of purchase After the qualifying product(s) are installed, complete the Rebate Form. Mail completed form along with your proof of purchase to: Merced Irrigation District Attention: Public Purpose Program Manager P.O. Box 2288 Merced, CA 95344-0288 3. Keep a copy of your completed Rebate Form Keep copies of all documents including the signed and dated Rebate From and proof of purchase before submitting for rebate. 4. Be prepared to participate in any required verification of installation MID may verify the energy-efficient product(s), customer eligibility and installation prior to payment of rebate. TERMS AND CONDITIONS – Read, sign and date As a qualified MID customer, I certify that I have purchased the indicated energy-saving product(s) for use in my home and not for resale. I agree to verification by MID of both the sales transaction(s) and product installation and I certify that the information on this application is true and correct. I understand that rebate payment(s) are based on related energy benefits over the life of this product.
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Residential Home Energy Efficiency Rebate Application 744 West 20th St. PO Box 2288, Merced, CA 95340 Phone: 209-722-5761 Fax: 209-726-7010 Page 2 of 4

Merced Irrigation District

I agree that: 1. I must be a residential customer on a residential rate with an active meter serviced by MID. The product(s) I have installed shall be designated to reduce the energy consumption distributed to me by MID at the installation address above. 2. I understand the rebate offer is limited to residential customers for residential use. The energyefficient product(s) must be installed in a residential dwelling within MID’s service area and must have been purchased within 12 months of the submittal of this application. 3. Resale products, products leased, rebuilt, rented, received from insurance claims, won as a prize or new parts installed in existing products do not qualify. 4. I understand that this signed and dated Rebate Form, all appropriate proof(s) of purchase, and other required documentation as referenced in this application must be sent to MID. 5. A rebate check for qualifying product(s) is generally mailed 6 to 8 weeks after MID receives and approves a completed application including all required documentation. Additional time may be necessary if an application is selected for verification. 6. I understand that the selection of qualifying product(s), manufacturer, dealer, supplier and/or installer and purchase, installation and ownership/maintenance of the qualifying product(s) referenced in this application are my sole responsibility. I understand that my manufacturer, dealer, supplier or installer of these products and measures is not an agent or representative of MID. I understand that MID makes no representation regarding manufacturers, dealers, contractors, materials or workmanship. I ALSO UNDERSTAND THAT MID MAKES NO WARRANTY WHETHER EXPRESSED OR IMPLIED, INCLUDING WITHOUT LIMITATION THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR ANY PARTICULAR PURPOSE, USE OR APPLICATION OF THE PRODUCTS OR MEASURES. I agree that MID has no liability whatsoever concerning (1) the quality, safety and/or installation of the product(s) or measures, including their fitness for any purpose; (2) the estimated energy savings of the product(s) or measures; (3) the workmanship of any third parties, (4) the installation or use of the product(s) or measures including, but not limited to, effects on indoor pollutants; and any other matter with respect to the MID Home Appliance Rebate program. I waive any and all claims against MID, its directors, officers, employees, or agents arising out of activities conducted by or on behalf of MID in connection with my application for any rebate(s) under the MID Home Appliance Rebate Program. I have read and understand the above terms and conditions. I certify that the information I have provided is true and correct and the product(s) and/or equipment for which I am requesting a rebate meets the requirements in this rebate form. Customer Signature: Name: Date:

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Residential Home Energy Efficiency Rebate Application 744 West 20th St. PO Box 2288, Merced, CA 95340 Phone: 209-722-5761 Fax: 209-726-7010 Page 3 of 4

Merced Irrigation District

Residential Home Energy Efficiency Rebate Application and Instructions
Provide all information requested on this Rebate Form for all products purchased and installed. HOME IMPROVEMENT
A. Energy Star® LABELED Ceiling Fans Customer Unit(s) _______ Or Contractor

QUANTITY PURCHASED A

INSTALLED BY

REBATE/UNIT B
$20.00/unit Manufacturer Name:

REBATE TOTAL = AxB

□ □

Model Number: Purchased Date: Installed Date:

$___________

B. Whole House Fan Customer Unit(s) _______ Or Contractor

$100.00/unit Manufacturer Name:

□ □

Model Number: Purchased Date: Installed Date:

$___________

C. Energy Star® LABELED Compact Fluorescent Lights 19 watt or less screw-in lamp 20 watt or greater screw-in lamp 64 watt or less torchiere lamp 65 watt or greater torchiere lamp Interior Hardwire Fixtures 19 watt or less 20 watt or greater Exterior Hardwire Fixtures 19 watt or less 20 watt or greater Unit(s) ________ Unit(s) ________ Unit(s) ________ Unit(s) ________ Unit(s) ________ Unit(s) ________ Unit(s) ________ Unit(s) ________ $1.00/lamp* $2.00/lamp* $5.00/lamp* $10.00/lamp* $8.00/lamp* $16.00/lamp* $8.00/lamp* $16.00/lamp* Purchased Date: ______________ *Up to 50% of total cost. Installed Date: _______________ $__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________

Customer Or Contractor

□ □

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Residential Home Energy Efficiency Rebate Application 744 West 20th St. PO Box 2288, Merced, CA 95340 Phone: 209-722-5761 Fax: 209-726-7010 Page 4 of 4

Merced Irrigation District

Residential Home Energy Efficiency Rebate Application and Instructions
For Office Use Only Approved By: Verified By: Total Rebate Amount: $ Title: Date of Inspection: Approved/Denied:

The Energy Star® is your assurance of energy efficiency performance that exceeds federal standards. When used properly, Energy Star® products use less energy than standard equipment. Therefore, they cost less to operate and create less pollution.

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