Residential Equipment Rebate Application

"*" indicates required fields

Property Owner's Name(s)*

Name on Account (if different)

Email*

Daytime Phone Number*

Address Where Equipment is installed (include unit # if applicable)*

Street Address City ZIP Code

Check Payable To (if different than property owner)

Name Mailing Address City State ZIP Code

What type of home do you have?*

Single Family House Detail*

Installation Contractor's Name*

Installation Contractor's State Gas Certification or License Number*

Available from contractor

Installation Contractor's Address

Street Address City State ZIP Code

Type of Equipment*

Equipment Make*

Equipment Model #*

Equipment Rated Efficiency (AFUE)

Equipment Heating Capacity (Input BTUH)

Equipment Serial Number*

Contractor's Final Invoice (Must include: BTU size, make, model and serial number of the installed equipment.)*

Max. file size: 50 MB.

Date Equipment was Installed*

Notes

Terms And Conditions*

I Acknowledge Rebate Program Terms and Conditions*

1. Rebate requests must be made within 90 days of the completed installation of equipment and must be
installed at a valid Vermont Gas account address.
2. All Equipment must have an active listing with the American Heating and Refrigeration Institute (AHRI) or
Energy Star to be considered for a rebate. Manufacturer’s claims will not be considered.
3. Customers must provide the Contractor’s final invoice to Vermont Gas for
payment. Contractor’s invoice must include: size, make, model and serial number of the installed equipment.
4. Equipment must be installed by a Natural Gas Certified contractor.
5. All required information must be provided to be eligible for a rebate. Incomplete applications, missing data,
or ineligible equipment may result in the delay or disqualification of the rebate.
5. All Equipment must be installed to manufacturers instructions and operating according to all applicable
federal, state and local codes and ordinances. Vermont Gas has not inspected or tested the installation and it
has no responsibility for such compliance. Performance of installed equipment is not guaranteed expressly
or implicitly.
6. Vermont Gas reserves the right to confirm all installations to verify the accuracy of the efficiency rating of the equipment installed.
7. Rebate amounts and conditions are subject to change without notice.

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Residential Equipment Rebate Application

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