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REBATE APPLICANT INFORMATION

ACCOUNT NAME - as it appears on utility bill PROPERTY TYPE BWP ACCOUNT NUMBER
(required)

Own Rent

Single Family

Multi-family

(apartments, condos, duplex, triplex etc.)

DAYTIME PHONE NUMBER

ADDRESS OF APPLICATION INSTALLED MAILING ADDRESS (to send rebate check to)

CITY CITY

ZIP ZIP

EMAIL ADDRESS

PURCHASE INFORMATION

SUPPORTING DOCUMENTION REQUIRED

COMPLETE ALL APPLICABLE SECTIONS ON THE BACK OF TA THIS FORM FOR EACH APPLIANCE TO BE REBATED

Proof of Purchase such as sales receipts and/or invoices.


Copy of Energy Guide Label showing ENERGY STAR for the following products: Ceiling Fan Clothes Washer Dishwasher Refrigerator Room Air Conditioner
Visit EnergyStar.gov for qualifying products

Low-E Dual Pane Window Label (ONLY FOR WINDOW REBATES)


If label is not available, please submit the manufacturers order confirmation sheet. s The manufacturers order confirmation sheet must be on the manufacturers letterhead and include the specific U-Factor of .40 or less and a Solar Heat Gain Coefficient (SHGC) of .40 or less.

National Fenestration Rating Council (NFRC) label can be found on each window.

(only for Windows)

CUSTOMER: PLEASE SIGN


By signing below, I certify that I have read, understand and agree to abide by the terms and conditions herein and that the information on this rebate form and on the attached supporting documents is accurate and complete. In addition, I certify that the installation of all energy efficient upgrades and/or equipment complies with applicable permitting requirements and that any contractor used to perform the work holds the appropriate license.
AUTHORIZED SIGNATURE: DATE:

MAIL-IN INSTRUCTIONS

MAIL APPLICATION WITH SUPPORTING DOCUMENTS TO: BWP CONSERVATION P.O. Box 631 Burbank, CA 91503-0631
If you have any questions contact BWP Conservation at (818) 238-3730 or visit BurbankWaterAndPower.com
ELIGIBILITY

TERMS AND CONDITIONS


I will provide if requested, a BWP representative reasonable access to my residence to verify installation of measures. I understand that a rebate will not be paid if I refuse the request for verification. Rebates are not guaranteed. This program is subject to change without notice. I am responsible for filling out the application completely, truthfully and accurately. I understand that BWP is not responsible for items lost or destroyed in the mail/transit.

I understand that I must be a BWP customer with an active BWP account. If I am a tenant, I am responsible for obtaining the property owners permission to install the measure for which I am applying. My signature on this application indicates that I have obtained this permission.

APPLICATION

This signed and dated application, copies of proof of purchase and other required supporting documentation must be sent to BWP Conservation postmarked no later than FOUR months from date of purchase.

PAYMENT

Payment of the rebate is conditional upon all correct supporting documentation being submitted with the application. The rebate check will be mailed for qualifying item(s) within three months of receiving the completed application. The rebate check cannot exceed the products purchase and installation costs.

Southern California Gas Company, socalgas.com Metropolitan Water District, bewaterwise.com Federal/State tax credits, please consult your tax professional for more information.

ADDITIONAL REBATES

Date Application Received

FOR BWP USE ONLY Total Rebate Amount

Purchased
In Burbank Out of Burbank or Online

CEILING FAN
(Limit 3)

Manufacturer

$25

$15

Model # Purchase Date Quantity Manufacturer Water Heater Type: Gas Electric

CLOTHES WASHER
$100 $75

Model # Purchase Date

DISHWASHER
$75 $50

Manufacturer Model # Purchase Date

REFRIGERATOR/ FREEZER
Full size capacity 15 cubic feet minimum. This rebate requires you to have an existing refrigerator. Existing refrigerator must be recycled using one of the following methods: 1 Burbank Public Works (818 )238-3800 OR 2. Retail Store (location of purchase) may haul away. Make sure receipt reads Haul Away.

Manufacturer Model # Purchase Date Public Works Pick Up Date Retailer Haul Away Date Manufacturer
OR

$150

$100

ROOM AIR CONDITIONER


$75 $50

Model # Purchase Date Quantity

LOW E-GLASS WINDOWS AND DOORS


For existing window replacements only. Must have a U-Factor* of .40 or less and Solar Heat Gain Coefficient (SHGC) ** of .40 or less *U-Factor: measure of the heat flow through the window. **SHGC: measure of how well a window absorbs or reflects heat from the sun.

Square footage (Sq. Ft.) equals: Width (inches) x Height (inches) and divide by 144

$2 Per Sq. Ft.

$1 Per Sq. Ft.

Total Sq. Ft for Windows Manufacturer Purchase Date Tonnage Manufacturer Purchase Date * SEER = Seasonal Energy Efficiency Ratings found on the specification sheet provided by manufacturer. Total Sq. Ft. of insulation installed

CENTRAL AIR CONDITIONING


Minimum 14 SEER* rating for packaged and split systems. Submit supporting documents showing tonnage and SEER.

SEER 14 - 14.9 SEER 15 - 15.9 SEER 16+

$100/ton $120/ton $140/ton

$80/ton $100/ton $120/ton

ATTIC INSULATION
The final insulation level must be R-30 or R-19 if there is less than 24 of attic clearance. Submit supporting documentation showing total square feet and level of insulation. New construction is not eligible for this rebate.

$0.15 Per Sq. Ft.

$0.10 Per Sq. Ft.

Manufacturer Finished Insulation Level Purchase Date Manufacturer

POOL PUMP
Only variable speed replacement pool pumps are eligible. Supporting documents must include make and model number. Spa pumps, single speed, and two speed pumps not eligible.

$100

$50

Model # Purchase Date

SOLAR ATTIC FAN


All solar attic fans are eligible. (Limit 3)

$200

$200

Solar Attic Fan rebate requires an additional supplemental form.

Please contact BWP Conservation for details 818-238-3730

WALL INSULATION
Existing walls must be un-insulated and the installed insulation must achieve a minimum of R-13. Submit supporting documentation showing total Sq. Ft. and level of insulation. New construction is not eligible for this rebate.

Total Sq. Ft. of

$0.15 Per Sq. Ft.

$0.10 Per Sq. Ft.

Insulation Installed Manufacturer Purchase Date Manufacturer Total Sq. Ft. Of Home?

WHOLE HOUSE FAN


All whole house fans are eligible.

$100

$50

Model # Purchase Date

ADDITIONAL REBATES: RAIN BARREL


Available for BWP customers using electric water heaters only.

$100 $1500

$100 $1500

SOLAR WATER HEATER

Solar Water Heater and Rain Barrel require an additional supplemental form.

Please contact BWP Conservation for details (818) 238-3730