Rebate

2010 Application No.

Energy Star ®
Air Conditioning/Heat Pump Rebate Program
Residential Rebate Request Form
& Eligibility Requirements
QUALIFICATIONS: PLEASE NOTE:
• THIS PROGRAM IS FOR RETROFIT ONLY. FUNDS CANNOT • Roseville Electric has partnered with the Electric & Gas Industries
BE USED FOR NEW CONSTRUCTION. Association (EGIA) for the administration of this program.
• All equipment must be installed in a residential dwelling receiving
electricity from Roseville Electric and must be purchased new at retail price.
• OFFER IS VALID FROM JANUARY 1, 2010 – JUNE 30, 2010, OR • Do not include rebate application with your utility bill.
UNTIL FUNDS ARE DEPLETED, WHICHEVER COMES
FIRST. ALL APPLICATIONS MUST BE POSTMARKED NO • Roseville Electric and EGIA reserve the right to verify both the efficiency and
LATER THAN 60 DAYS AFTER INSTALLATION, OR BY 6/30/10, installation of equipment before rebate is issued.
WHICHEVER COMES FIRST. HOWEVER, APPLICATIONS
RECEIVED AFTER MAY 31, 2010, CANNOT BE PROCESSED • Roseville Electric and EGIA are not responsible for items lost or delayed in
UNLESS FUNDS ARE RESERVED PRIOR TO MAY 31, 2010. To the mail, nor any remittance delayed due to incorrect rebate applications.
reserve funds, the customer or contractor must submit a copy of the
contractor’s proposal to EGIA via fax @ 800-506-9073. EGIA will then • Roseville Electric and EGIA disclaim any and all liability, loss or damage
confirm receipt and supply the customer or contractor with the
reservation code. WITHOUT A RESERVATION, FUNDS CANNOT that may arise as a result of the applicant’s or contractor’s participation
BE GUARANTEED. in this program.
• Units must have a thermal expansion valve (TXV) to qualify.
• Both inside and outside coils on a split system must be changed and • Roseville Electric and EGIA are not responsible for any taxes that may be
must match to verify efficiency. imposed as a result of your receipt of any financial rebates from Roseville
• NEW: Air conditioning rebates now require a signed and dated Electric.
building permit and the Installer Compliance Statement For Duct
Leakage and TXV verification (pages 4-5 of Residential Compliance • Rebates may not exceed the cost of the energy efficient equipment.
Form CF-6R). You can get this form from your contractor or download
it at www.conservationrebates.com.
• After installation, please fill out, sign and mail this application. • For more program information, or to verify program requirements, please
Include copies of receipts that describe the system installed, including visit www.conservationrebates.com or contact the program administrator,
cost, model numbers, SEER and EER, and a copy of the building EGIA, at 877-419-7271.
permit and Installer Compliance Statement For Duct Leakage form.
Tear here and retain the above section for your records. Return completed portion below with a copy of your sales receipt.

How did you hear about this program? ■ Website ■ Newspaper/Magazine Rebate
■ Called RE ■ Outreach Event ■ Friend/Relative ■ RE Newsletter ■ Other Application No.
■ Check this box to be enrolled in the Power Partners AC cycling program and receive $10 for joining and $10 each summer you participate – see www.roseville.ca.us/PowerPartners for details.
Please complete the required information below:
Would you have purchased and installed this energy efficient measure if Roseville Electric didn’t offer a rebate? ■ Yes ■ No
PURCHASER PAYEE
Roseville Utility Account Number
■ Contractor ■ Landlord ■ Purchaser
—
Name Name

Installation address Mailing Address

City State Zip Telephone City State Zip Telephone

Equipment Information Old Equipment New Equipment

Manufacturer's Name
Model Number
Serial Number
Date Purchased/Date Installed /
Efficiency Rating SEER: EER: SEER: EER: HSPF:
Number of Tons
Total Rebate
The amounts below supersede all rebate values previously stated on any preceding application.
Energy Star® Air Conditioning Rebate Heat Pump System Incremental (Flat) Rebate
Split System Package System
Split System with TXV Package System with TXV
with TXV
14.5 SEER / 12.0 EER 15 SEER / 12.5 EER 14 SEER / 11 EER 14 SEER / 12 EER 8.5 HSPF 8.2 HSPF
$550 / unit $750 / unit $550 / unit $750 / unit $200 / unit $200 / unit
Mail Form To: Roseville Electric Rebate Program
3800 Watt Ave., Suite 105
Sacramento , CA 95821

X
Purchaser Signature (REQUIRED) Date
 Visit www.conservationrebates.com to:

• Print Out An Application

• View and Print Qualifying Product Lists
• Find an Eligible Contractor In Your Area
• Get Additional Program Details

Have you enclosed a copy

of your invoice or
contractor’s proposal?

Thank you for participating in the

Roseville Electric Energy Star ®
Air Conditioning/Heat Pump Rebate Program
Valid on purchases from January 1, 2010 – June 30, 2010, or until available funds are depleted.
REMINDER:
Eligibility Requirements:
• Units must have a thermal expansion valve (TXV) to qualify.
• Copy of signed and dated building permit and Installer Compliance Statement For Duct Leakage
form must be enclosed with this application.
• FUNDS MAY NOT BE USED FOR NEW CONSTRUCTION. THE PROGRAM IS FOR
RETROFIT ONLY.
• A reservation is required. Funds are not guaranteed unless a reservation has been made.
• All rebate requests must provide a receipt and a verification of the efficiency level installed.
Rebates will not exceed the cost of the measure.
• All reservations must be submitted by May 31, 2010. For payment, all Rebate Request Forms
must be completed and postmarked within 60 days of installation or by June 30, 2010, whichever
comes first.
Allow four (4) to six (6) weeks from the time we receive your complete rebate request form to process your
rebate. If an inspection is required, your rebate will be processed within three weeks of the inspection.
— SAVE THIS PORTION FOR YOUR RECORDS — RECYCLED PAPER
Return Address
PLACE
___________________________________________________
STAMP
___________________________________________________ HERE
___________________________________________________
ROSEVILLE ELECTRIC
AIR CONDITIONING/HEAT PUMP REBATE PROGRAM
3800 Watt Ave. Ste. 105
Sacramento, CA 95821