8/6/2019 2011 CO Heating Rebate Form

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Residential aPPliCatiOn 

COlORadO

Re rete qifctin n the c pge thi rm.

 

Xcel Energy Account Number where unit was installed __________________________________________________________________________

Customer Name (PRINT) _______________________________________________ Daytime Phone ( ________ ) ___________________________(As shown on your utility bill)

Installation Address (PRINT) ________________________________________ City _________________________ State ______ ZIP _________

Mailing Address (PRINT) ___________________________________________ City _________________________ State ______ ZIP _________(I dierent rom installation address)

Hw i y ern t the Xce Energy rete? (check all that apply)  

Xcel Energy Web Site Xcel Energy Call Center Agent Installing Contractor Email

Direct Mail Radio/TV/Internet Advertising Print Advertising

A riend or neighbor who already participated in a rebate program Other _________________________________________

Customer hereby certies that 1. the customer is solely responsible or the accuracy o the application inormation; 2. all installation is complete and operational prior to submitting thisapplication; 3. all rules o this Xcel Energy program (listed on back) have been ollowed; 4. Xcel Energy is not liable or any work perormed.

CustomerSignature ___________________________________________________________________________________ Date ___________________

C

Manuacturer (PRINT) _________________________________________________ Model # (ull – as lIsTEd oN aHRI) __________________________

Serial Number __________________________________________________ Size or Capacity (bTu)____________ Efciency (auE)___________

Rebate Amount $ _____________________________ 1. Does the new urnace have a variable speed an? Yes No

2. Did you also replace your central air conditioner? Yes No3. Did Xcel Energy rebate infuence your buying decision? Yes No

 

Contractor/Retailer Company Name (PRINT) _____________________________________________________________________________________

Contact Person (PRINT) ____________________________________________ Phone __________________________________________________

Address _______________________________________________________ City _________________________ State ______ ZIP _________

Xcel Energy Contractor ID # (lEavE blaNk I sEl-INsTallEd)_____________________________

I hereby certiy that all inormation is accurate, including claims o eciency, size and customer inormation. 

Contractor

Signature (lEavE blaNk I sEl-INsTallEd) ________________________________ Date ______________________________________________

oR REbaTE oPERaTIoNs usE oNlY. do NoT WRITE IN THIs aREa.

RECEIVED BY: ______________________________________ LETTER SENT BY: ___________________________________ REBATE AMT: ______________________________________

COMPLETED BY: ____________________________________ ________________________________________________ DATE PURCHASED: __________________________________

________________________________________________ DATE INSTALLED: ___________________________________

Ctmer Inrmtin

aternte Rete Recipient: Complete this section only i the rebate should be issued to someone other than the customer named above.

Name (PRINT) _____________________________________________________ Daytime Phone ( ________ ) ____________________________

Address ______________________________________________________ City __________________________ State ______ ZIP ________

I authorize the above party to receive the rebate check.

Customer

Signature __________________________________________________________________________________________ Date ____________

Eqipment Inrmtin

Cntrctr/Retier Inrmtin

2011 Hg sym Rb

Page 1 of 2 Co Charge Code: 9774 10-11-524 | 01/2011 | CrS 1963

XCeL eNergY CoPY: WhITe CoNTraCTor/reTaILer CoPY: YeLLoW CUSToMer CoPY: PINK

Inttin dte: ___________________

8/6/2019 2011 CO Heating Rebate Form

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2011 heaTINg SYSTeM rebaTe  Residential aPPliCatiOn

  COlORadO

1-800-895-4999 | xceenergy.cm

© 2011 Xcel Energy Inc. | Xcel Energy is a registered trademark o Xcel Energy Inc. | Public Service Como Colorado, an Xcel Energy Company | 10-11-524 | 01/2011 | CRS 1963

Rete detiXcel Energy issues cash rebates in the orm o checks, not utility bill credits.Xcel Energy is not responsible i your contractor provided inaccurate inormationabout the amount and/or conditions o the actual rebate or equipment eligibility.Rebate requests within ve years o a previous request at the same premise willnot be accepted.

appictin detiQualiying equipment must be purchased and installed between January 1,2011 and December 31, 2011. Customers must apply or this rebate by July 31,2012. Applications must include complete contractor or retailer inormationand inormation about the equipment including: size or capacity, make, modelnumber, serial number and eciency rating.

N phne c wi e ccepte t prie erifctin thiinrmtin.

An application that is denied due to equipment ineligibility will not be acceptedwith changed model numbers.

A copy o the dated sales receipt or invoice must accompany completeinormation on the ront o this orm. The product invoice must speciy all

required inormation. Failure to complete this inormation will result in areturned application.

a inrmtin n the receipt r inice mt preciey mtch theinrmtin n the rete ppictin r the ppictin wi nt eprcee.

We reserve the right to conduct random inspections to veriy installation othe rebated equipment at the address indicated on the ront o this orm. I weselect your application or a random inspection, the rebate application will notbe processed until the inspection has been satisactorily completed. Inspectionsmay also be perormed ater rebate payment at Xcel Energy’s discretion.

limittinRebate qualications and amounts are subject to change any time. Our rebate

programs may be cancelled with 30 days notice.

Please visit us at xcelenergy.com/homerebates or call 1-800-895-4999 todetermine whether any program changes have occurred.

speci PrmtinDuring special promotions or this program, it is the customer/contractor’sresponsibility to ensure all paperwork is postmarked by the deadline. Xcel Energywill not pay special promotion incentive dollars in the event that a orm is lostor not postmarked by the deadline. No exceptions. Promotional rebate amountswill be automatically calculated by Xcel Energy. Promotion deadlines close atmidnight on the date the application is due, with no exceptions.

Hep With rmI you are building a new home, you must obtain a sales receipt or the

equipment rom your builder or retailer. Only one rebate per piece o equipmentwill be paid.

I you have questions while lling out this orm, please contact your contractor orretailer or assistance. Please allow at least six weeks or your rebate to arrive.

Qiying CtmerXcel Energy natural gas residential customers in Colorado are eligible or rebateswhen buying qualiying, high-eciency, new urnace or boiler (reconditionedequipment is not eligible).

 

The program is applicable only or the purchase and installation o qualiying gasurnaces or boilers sold by participating contractors or retailers or installation innew or replacement applications where natural gas is supplied by Xcel Energy.

Participants understand they are not eligible to receive additional rebates or thiimprovement through a dierent Xcel Energy Rebate program.

EQuIPMENT auE 2011 REbaTEFurnace 92% $80

Furnace 94% $120

Boiler 84% $100 Note: You may qualiy or additional rebates rom your local communityand/or the Governor’s Energy Oce. Please visit www.rechargecolorado.comto learn more.

Rebates or new home construction should be negotiated between the builderand resident or new home buyer to determine who receives the rebate.

Qiying Eqipmentony eqipment ite n the aHRI ite (www.hriirectry.rg—

reienti ectin ny) i eigie r rete. Eciency ratings aredetermined using the Air-Conditioning, Heating, and Rerigeration Institute(AHRI), www.ahridirectory.org (residential section only). I more than one unit isinstalled at an address, one rebate orm per unit is required to receive a rebateor each unit.

Submitting an AHRI certicate with your application and invoice is highlyrecommended. The AHRI list o qualiying equipment is dynamic and changesrequently. AHRI certicates that are printed, within 2 weeks o the installationdate, and sent in with the rebate application will be honored even i theequipment is no longer listed on the dynamic website list.

Please include the items listed below on your application orm andpurchase receipt. I all o the items are not included the application

will be returned.sen t Xce Energy (n eep cpy):

1. Yr prche receipt/inice, with thee eti:

Customer name

Installation address

Brand

Model number

Size or capacity

Serial number

Invoice date

Eciency level

2. Thi rete rm, cmpetey fe t (No blaNks)

Contractors keep a copy of the application form and invoice.

Send Complete Applications to:

Xce Energy Rete opertinP.o. bx 829Minnepi, MN 55440-0829