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Residential Equipment Rebate Application

"*" indicates required fields

Contact Info

Address Where Equipment is Installed (include unit # if applicable)*
Check Payable To (if different than property owner)

Contractor Info

Available from contractor or: VT Licensed Plumbers
Installation Contractor's Address

Equipment Info

MM slash DD slash YYYY
Max. file size: 50 MB.

Terms & Conditions

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.

Income-Eligible Bonus Rebate

Is your household gross annual income less than the amounts listed in the table below?
(Income-qualified households may be eligible for a bonus rebate on certain equipment)
Number of People in Household123456+
Chittenden & Franklin Counties$90,200$103,200$116,000$128,800$139,200$146,600
Addison County$78,700$89,900$101,200$112,300$121,320$130,300
Income is defined as the total annual gross income of all family and non-family members 18+ years old living within the household. To calculate income, take the monthly amount from the last one-to-two paychecks for yourself and the people in your household (before taxes) and multiply by 12. Include all wages, including regular salaries and overtime. If you are self-employed, use the previous month of pretax income and multiply by 12.

All sources of income must be counted from all persons in the household based on anticipated income expected within the next 12 months. Possible types of income include but are not limited to: wages, salary, tips, bonuses or commissions payments, public assistance, social security/SSI, child support, regular gifts, unemployment, income earned on assets (savings, IRA, etc.) and some types of financial aid.
Consent*
I understand that this self‐certification may be subject to further verification by Vermont Gas Systems or the Vermont Department of Public Service. If requested, I agree to provide Vermont Gas Systems or the Vermont Department of Public Service with the information or documentation required to verify my household annual income (e.g., pay stubs, bank account statements, tax returns, etc.).
MM slash DD slash YYYY

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85 Swift Street
South Burlington, VT
05403

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(No in-person staffing due to COVID until further notice)

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