100110 Roseville AirCond Rebate 6/28/10 12:34 PM Page 1

Rebate
ENERGY STA R ®
Air Conditioning/Heat Pump Rebate Program
Residential Rebate Request Form
& Eligibility Requirements
QUALIFICATIONS:
• THIS PROGRAM IS FOR RETROFIT ONLY. FUNDS CANNOT
BE USED FOR NEW CONSTRUCTION.
• All equipment must be installed in a residential dwelling receiving
electricity from Roseville Electric and must be purchased new at retail price.
• OFFER IS VALID ON PURCHASES FROM JULY 1, 2010 –
JUNE 30, 2011. ALL APPLICATIONS MUST BE POSTMARKED
NO LATER THAN 60 DAYS AFTER INSTALLATION. To reserve
funds, the customer or contractor must submit a copy of the
contractor’s proposal to EGIA via fax @ 800-506-9073. EGIA will then
confirm receipt and supply the customer or contractor with the
reservation code. RESERVATIONS ARE REQUIRED. WITHOUT
A RESERVATION, FUNDS WILL NOT BE GUARANTEED.
• Units must have a thermal expansion valve (TXV) to qualify.
• Both inside and outside coils on a split system must be changed and
must match to verify efficiency.
• Rebate applications require a signed and dated building permit.
• After installation, please fill out, sign and mail this application.
Include copies of receipts that describe the system installed, including
cost, model numbers, SEER and EER, ARI number and a copy of the
building permit.
Tear here and retain the above section for your records. Return completed portion below with a copy of your sales receipt.
2010/2011 Application No.
PLEASE NOTE:
• Customers may be eligible for additional rebates if there is a change in
residence.
• Roseville Electric has partnered with the Electric & Gas Industries
Association (EGIA) for the administration of this program.
• Do not include rebate application with your utility bill.
• Roseville Electric and EGIA reserve the right to verify both the efficiency and
installation of equipment before rebate is issued. If installation can not be
verified, the customer may be expected to return some or all of the rebate
received.
• Roseville Electric and EGIA are not responsible for items lost or delayed in
the mail, nor any remittance delayed due to incorrect rebate applications.
• Roseville Electric and EGIA disclaim any and all liability, loss or damage
that may arise as a result of the applicant’s or contractor’s participation
in this program.
• Roseville Electric and EGIA are not responsible for any taxes that may be
imposed as a result of your receipt of any financial rebates from Roseville
Electric.
• Rebates may not exceed the cost of the energy efficient equipment.
• By accepting a rebate from the City of Roseville, I understand that the city or
it's assignee, may conduct an on-site pre and post project inspection and
measurement and verification analysis. This may require sharing my name,
address, electricity usage, or other needed information with a consultant for
these purposes.
• For more program information, or to verify program requirements, please
visit www.conservationrebates.com or contact the program administrator,
EGIA, at 877-419-7271.

How did you hear about this program? ■ Website ■ Newspaper/Magazine Rebate
■ Called RE ■ Outreach Event ■ Friend/Relative ■ RE Newsletter ■ Other ______________________ Application No.
■ Check this box to be enrolled in the Power Partners AC cycling program and receive $10 for joining and $10 each summer you participate – see www.roseville.ca.us/PowerPartners for details.
Please complete the required information below:
Would you have purchased and installed this energy efficient measure if Roseville Electric didn’t offer a rebate? ■ Yes ■ No
PURCHASER PAYEE
Roseville Utility Account Number
■ Contractor ■ Landlord ■ Purchaser
—
Name Name

Installation address Mailing Address

City State Zip Telephone City State Zip Telephone

Equipment Information Old Equipment New Equipment

Manufacturer's Name
Model Number
Serial Number
Date Purchased/Date Installed /
Efficiency Rating SEER: EER: SEER: EER: HSPF:
N um ber of To n s
Total Rebate
The amounts below supersede all rebate values previously stated on any preceding application.
ENERGY STAR® A i r C o n d i t i o n i n g R e b a t e Heat Pump System Incremental (Flat) Rebate
Split System Package System
Split System with TXV Package System with TXV
with TXV
14.5 SEER / 12.0 EER 15 SEER / 12.5 EER 14 SEER / 11 EER 14 SEER / 12 EER 8.5 HSPF 8.2 HSPF
$550 / unit $750 / unit $550 / unit $750 / unit $200 / unit $200 / unit
Mail Form To : Roseville Electric Rebate Program
3800 Watt Ave., Suite 105
Sacramento , CA 95821

X
Purchaser Signature (REQUIRED) Date
100110 Roseville AirCond Rebate 6/28/10 12:34 PM Page 2

Visit www.conservationrebates.com to:

• Print Out An Application

• View and Print Qualifying Product Lists
• Find an Eligible Contractor In Your Area
• Get Additional Program Details

Have you enclosed a copy

of your invoice or
contractor’s proposal?

Thank you for participating in the

Roseville Electric
ENERGY STAR ®
Air Conditioning/Heat Pump Rebate Program
Valid on purchases from July 1, 2010 – June 30, 2011, or until available funds are depleted.
REMINDER:
Eligibility Requirements:
• Units must have a thermal expansion valve (TXV) to qualify.
• Copy of signed and dated building permit.
• FUNDS MAY NOT BE USED FOR NEW CONSTRUCTION. THE PROGRAM IS FOR
RETROFIT ONLY.
• A reservation is required. Funds are not guaranteed unless a reservation has been made.
• All rebate requests must provide a receipt and a verification of the efficiency level installed.
Rebates will not exceed the cost of the measure.
• All reservations must be submitted by May 31, 2010. For payment, all Rebate Request Forms
must be completed and postmarked within 60 days of installation.
Allow four (4) to six (6) weeks from the time we receive your complete rebate request form to process your
rebate. If an inspection is required, your rebate will be processed within three weeks of the inspection.

— SAVE THIS PORTION FOR YOUR RECORDS — RECYCLED PAPER

Return Address
PLACE
___________________________________________________
STAMP
___________________________________________________ HERE
___________________________________________________
ROSEVILLE ELECTRIC
AIR CONDITIONING/HEAT PUMP REBATE PROGRAM
3800 Watt Ave. Ste. 105
Sacramento, CA 95821
Page 3 12:34 PM 6/28/10 100110 Roseville AirCond Rebate