NGEMC-TVA energy right® Residential

Water Heater Program Rebate Application

HOMEOWNER:_____________________________________________ DATE: ________________________________

ADDRESS:_______________________________________________________ACCOUNT NO: ____________________

CITY:__________________________ COUNTY:_________________ STATE:_________ ZIP CODE:_______________

HOME PHONE:_____________________________ DAY TIME PHONE (if other):____________________________

PURCHASE PRICE: ____________________________ DATE OF PURCHASE:____________________________

PLACE OF PURCHASE (Name and Address): _____________________________________________________________

INSTALLED BY (Name and Address):___________________________________________________________________

DATE OF INSTALLATION:______________________ LOCATION INSTALLED (Where in Home):________________

EQUIPMENT MANUFACTURER:______________________________EQUIPMENT WARRANTY (Years):__________

SERIAL NUMBER:__________________________ MODEL NO. _____________________TANK SIZE (Gallons)______

TYPE OF WATER HEATER: (Circle One)

STANDARD ELECTRIC HIGH EFFICIENCY ELECTRIC (Must have a 10-year tank warranty and a minimum
energy factor of .90 or higher.)

IMPORTANT NOTE: TO BE ELIGIBLE FOR THIS REBATE, THE APPLICANT/HOMEOWNER MUST AGREE TO AN ON-
SITE VERIFICATION OF THE INSTALLATION OF THE WATER HEATER BY AN AUTHORIZED NGEMC OR TVA
REPRESENTATIVE. HOWEVER, NORTH GEORGIA ELECTRIC MEMBERSHIP CORPORATION AND TENNESSEE
VALLEY AUTHORITY NEITHER WARRANTS NOR INSPECTS THE EQUIPMENT, INSTALLATION, OR WIRING OF
THIS APPLIANCE AND ARE NOT RESPONSIBLE FOR ANY DEFECTS IN ITS INSTALLATION OR PERFORMANCE.

SIGNATURE (Home Owner):____________________________ NGEMC REP:___________________

Please attach copies of: proof of purchase (receipt); manufacturer’s description of water heater; and warranty information
to this form.

For Inspector’s Use Only

VERIFIED BY:_____________________________ DATE OF VERIFICATION: _____________

LOCATION OF HEATER:__________________________________ GALLONS: __________________

SERIAL NO. _________________ MAKE AND MODEL NO: _________________________________

SIGNATURE OF HOMEOWNER AT VERIFICATION:_______________________________________

(Revision: January 2004)

 RESIDENTIAL WATER HEATER REBATE

Incentive Level (For Single-Family Dwellings)

™ $25 Bill Credit: Replace water heater with a Standard Electric Water Heater
™ $50 Bill Credit: Replace water heater with a qualifying High-Efficiency Electric Water Heater

High-Efficiency Water Heater:

™ Must have a 10-year tank warranty or higher with an energy factor of .90 or higher,
™ Is classified as a heat pump/water heater, or
™ Is classified as an integrated water heating system that combines water heating with the heat/cooling system.

Program Requirements
Customers must meet the following requirements before bill credits can be applied:
™ Application for rebate must be made within 60 days of the water heater purchase.
™ Water Heater proof of purchase.
™ Water Heater model and serial numbers.
™ Warranty documentation and documentation stating water heater is electric
™ Water Heater must be installed and operable at the location designated on account to be credited. In the case of
rental property, landlord accounts can be credited with prior approval.
™ Installation of water heater is subject to onsite validation inspection.
™ Limit: one to two water heaters per residence.
The following documentation must be attached to rebate application:
™ Proof of purchase
™ Warranty information
™ Proof that water heater is electric
* Other Restrictions may apply.