City of Colton – Electric Utility Department

Photovoltaic Incentive Program

Rebate Application Form
Systems Smaller Than 30 kW

Applicant Information:

Customer Name: _____________________________ Utility Account Number: ______________

Contact Person: ______________________________ Phone Number: _____________________
Mailing Address: ________________________________________________________________
Residential Customer: _______ Business Customer: _______ Nontaxable Customer: ________
Installation Address: _____________________________________________________________

Installation Information:

Company Name: ________________________________________________________________

DBA Name: ____________________________________________________________________
Contact Person: ______________________________ Phone Number: _____________________
Contractor License Type: ________________________ License Number: ___________________
Mailing Address: ________________________________________________________________
City: ____________________________ State: __________________ Zip: __________________

Estimated Watt Production: ______________________ Watts X $4.00 = $__________________

Estimated System Cost: _______________________ Estimated Cost X 50% =$_______________
Estimated Rebate Amount: _______________________________________________________

(Estimated Rebate Amount is determined by comparing the Watt production calculation and the 50% calculation of
the estimated cost. Whichever value is less will determine the estimated rebate amount.

Rebate Payment Consent:

Rebate Payee: __________________________________________________________________

Make Check Payable to: __________________________________________________________
Mailing Address: ________________________________________________________________
City: ____________________________ State: __________________ Zip: __________________
Social Security Number: _____________________ Federal Tax ID Number: _________________
(If payable to customer) (If payable to Installer)

Photovoltaic Rebate Form Page 1 of 2

*Rebate check will be issued only after all of the work has been completed, after the installation has
been reviewed and authorized with a post installation inspection by the City of Colton Electric Utility
representative, and once itemized invoices with a copy of the final invoice stating the system and all
work has been paid in full, with no additional balance, has been received.

Signatures:

The undersigned warrants, certifies and represents that the information provided in this form is true
and correct to the best of my knowledge and that the installation will meet all of the City Colton Utility
terms and conditions.

Customer Name (Print): __________________________________________________________

Signature: _______________________________________ Date: _________________________

Installer Name (Print): ___________________________________________________________

Signature: _______________________________________ Date: _________________________

The above named customer agrees to abide by the rules and regulations of the City of Colton Electric
Utility Department’s PV Incentive Rebate Program and agrees to allow in The City of Colton Electric
Utility Department to claim the renewable energy production credits produced by the renewable energy
system that has received incentive funding from the City of Colton Electric Utility Department.

Authorization:

__________________________________ (Customer Name) has been granted a reservation of

$____________ for a _______________kW solar photovoltaic (System). The rebate shall be
paid to ______________________ (rebate payee), as agreed upon between the customer and
the installer (as noted above). The reservation will expire on ________________ (90 days from
the date of application approval). The system is being installed at ________________________
____________________________________________________________ (installation address).

Utility Representative Name: ______________________________________________________

Utility Representative Title: _______________________________________________________
Signature: _______________________________________ Date: _________________________

Photovoltaic Rebate Form Page 2 of 2