UNS Electric, Inc.

Efficient Home cooling Program

Rebate Application Form
Instructions for Completing Form:
1. Complete all sections of Rebate Application Form
2. Both the customer and contractor sign the Rebate Application Form
3. Contractor submits Rebate Application Form, copy of paid invoice and proper sizing calculations to: UniSource Bright Solutions – Rebate Processing CenterHome Cooling
Efficient
2001 N. 3rd Street, Suite 106
Phoenix, AZ 85004
Customer Information

Customer Name: UNSE Account Number at Installation Address:

Installation Address:

City: State: Zip: Installation Date:

Mailing Address (if different):

City: State: Zip:

Daytime Phone: Alternate Phone:

Dwelling Type: q Single Family Detached q Mobile Home q Condo/Townhouse q Other

How did you hear about this Program? q Web site q Newspaper q Magazine q Brochure q Radio q Television q Friend q Bill insert q Special Event Other

Equipment Information - Unit #1

New Equipment: Old Equipment:
q Packaged A/C q Split System q Heat Pump

Manufacturer: Estimated Age of unit:

Model # A/C Capacity: Ton

A/C Capacity: Ton SEER EER Rebate Amount (see rebate schedule on reverse side):

Condenser Model # Unit #1: $

Coil Model #

Furnace Model#

ARI Reference #

Equipment Information - Unit #2

New Equipment: Old Equipment:
q Packaged A/C q Split System q Heat Pump

Manufacturer: Estimated Age of unit:

Model # A/C Capacity: Ton

A/C Capacity: Ton SEER EER Rebate Amount (see rebate schedule on reverse side):

Condenser Model # Unit #2: $

Coil Model #

Furnace Model#

ARI Reference #

I certify that the high-efficiency equipment described above, and on the enclosed invoice, was installed at the location indicated. I agree to the Terms and Conditions on this rebate application form, as
they apply (see reverse side)

UNSE Customer Signature Date

I certify that the high-efficiency equipment described above, and on the enclosed invoice, was installed at the location indicated and that proper sizing calculations have been performed as indicated
on attached documentation. I agree to the Terms and Conditions on this rebate application form, as they apply (see reverse side)

HVAC Contractor Signature Date

Contractor ID#:

Paid for by UniSource Energy Services electric customers and approved by the Arizona Corporation Commission.
Participation in the UNSE Efficient Home Cooling Program is subject to the Terms and Conditions
Terms and conditions

Customer Eligibility:
1. Rebates will be paid only to residential customers of UNS Electric (UNSE). Current UNSE account number for the address where the equipment will be installed must be
included on the application. Installation must be on existing homes only; new homes are not eligible.

2. Equipment must be purchased and installed after June 13, 2008 to be eligible for a rebate. Rebate applications must be submitted within 90 days of installation. Please allow
6-8 weeks for rebate processing.

3. Equipment must be installed by a contractor holding a current license to install HVAC equipment in the state of Arizona.

4. Application must be filled out completely and signed by customer and contractor. Proof of purchase (copy of paid invoice) and documentation of proper sizing of equipment
must accompany the application to qualify for rebate incentive payment from UNSE. Invoice must include: manufacturer, model number, size (tons), SEER and EER,
installation date and contractor license number.

5. These incentives apply to total system replacements performed until funds are exhausted or program changes are made through the Arizona Corporation Commission.

6. Customer, in return for payment by the Company under the UNS Electric, Inc. Efficient Home Cooling Program, assigns any energy efficiency credits and all resultant
associated environmental credits from the energy efficiency measures for which the rebate is paid, to the Company.

Installation Verification:
7. UNSE reserves the right to conduct an on-site inspection solely for the purpose of verifying that equipment meets efficiency standards and installation guidelines outlined
in the program requirements. UNSE requires contractors to properly size and install all systems in accordance to ACCA Manual J calculations, or another recognized sizing
method.

Warranties, Liabilities and Release:

8. Neither UNSE nor any third party administrator of the Program guarantee, warrant or recommend any particular contractor, manufacturer or installer of equipment.

9. Participant hereby releases and shall indemnify, hold harmless and defend UNSE and any Program administrator from all losses, harm, costs, liabilities, damages and
expenses (including attorney’s fees) of any nature whatsoever arising directly or indirectly out of or in connection with the installation of equipment at the address listed on
this application form.

Changes to Efficient Home cooling Program:

10. The Program is subject to change without prior notice and rebate amounts may increase or decrease at any time

Tax Liability:
11. Participants in the Program may be subject to tax liability for the value of goods or services received through the Program pursuant to state or federal income tax codes.
Neither UNSE nor any Program administrators are liable for any tax liability which may be imposed on the participant as a result of receipt of rebate payments from UNSE.

Efficiency Level Incentive

14 SEER $200

15 SEER and above $250

Another Bright Solution from

For more information about the UNSE Efficient Home Cooling Program, or for assistance completing
your rebate application, please contact 1-866-322-4706 for general Program information please
contact us at 1-877-UES-4YOU or 1-877-837-4968 or visit our website at uesaz.com.