Rebate Coupon ( by ja8233

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									                                                                                              Coupon # __________________
                                                                                              Must be assigned by SCL before work begins

 Ductless Heat Pump Pilot Program
 Rebate Coupon (To be completed after installation of your ductless heat pump.)
 To receive the $1,200 rebate for your ductless heat pump as part of Seattle City Light’s pilot program,
 please complete this form and fax it along with a copy of your contractor’s final invoice to (206) 684-
 4220. (Or you can mail it to the address listed at the bottom of this page.) Only one rebate is
 available per home. Please complete the “Payment to Contractor” form on the reverse side if you
 wish to assign the rebate payment to your contractor.
 Please Print All Information Below:

 Homeowner (or Authorized Person) Name____________________________________________________

 Home Address __________________________________________________________________________
 City, State, Zip Code ______________________________________________________________________

 Contact Name_________________________________________ Phone ____________________________

 Contractor Name_______________________________________ Phone ____________________________

 SCL Electric Utility Account Number___________________________________________________________

 Seattle City Light ("SCL") will review the Owner or Authorized Personnel's ("Owner") rebate request coupon ("Request") and determine
 whether the installed Ductless Heat Pump (DHP) products qualify for the rebate. If the installed DHP products qualify, SCL will mail the
 appropriate rebate within thirty (30) days of SCL’s receipt of the Request. Only one rebate is available per home. By signing this
 Request and accepting any rebate, Owner (1) represents and warrants that Owner has installed all Ductless Heat Pump products in
 compliance with all applicable federal, state and local laws, codes, ordinances, including all building energy and accessibility codes and
 in compliance with the procedures specified by SCL for the Ductless Heat Pump Pilot Program; and (2) acknowledges and agrees that:
 (a) SCL has not and does not make any representations or promises with respect to the Ductless Heat Pump products, the energy
 consumption, and/or energy savings from the installed ductless heat pump products; and (b) that SCL MAKES NO IMPLIED OR
 EXPRESS WARRANTIES REGARDING THIS PROGRAM, ITS POLICIES, PROCEDURES, INSPECTIONS AND/OR ANY OWNER
 INSTALLED DUCTLESS HEAT PUMP PRODUCTS, AND SPECIFICALLY DISCLAIMS ANY WARRANTY OF MERCHANTABILITY
 OR FITNESS FOR A PARTICULAR PURPOSE.
 Owner certifies that all information provided herein is true and correct. Owner acknowledges and accepts SCL's right to
 inspect the installed Ductless Heat Pump products listed on the attached DHP invoice. Owner acknowledges that the Rebate
 Program is a limited offer and subject to the availability of funds, and that rebate amounts may be subject to change.


 ______________________________________________________________________________________________
 Signature of Homeowner or Authorized Person                                                   Date

 Mail to:                                                        OR                 Fax to:
 Seattle City Light                                                                 Ductless Heat Pump Pilot Rebate Program
 Conservation Resources Division                                                    Attn: Drew Hilen
 Attn: Drew Hilen                                                                   (206)684-4220
 700 5th Ave, Suite 3200. Rm 3420
 PO Box 34023
 Seattle, WA 98124-4023

OFFICE USE: SCL Authorized Rebate of $1200.

________________________ ___                 ___________________________                      Date:____________
City Light Authorization (Signature)         City Light Authorization (Print)
Ductless Heat Pump Pilot Program
Payment to Contractor Form
This form must be completed in order for Seattle City Light to issue rebate funds to the contractor.

Ductless Heat Pump Pilot Program rebate funds belong to the individual homeowner. The
individual homeowner may direct Seattle City Light to issue the rebate check to the contractor
who performed the work. If so, please complete the form below, making sure you have the
homeowner or authorized person’s signature where indicated on the form and return to
Seattle City Light with a copy of the invoice and Contractor’s W-9 Federal Tax Form.
I, Homeowner or Authorized Person, request the Ductless Heat Pump Pilot program rebate
check be issued in the name of:

Please Print All Information Below:



Payee Name                                                                Tax Id #
Mailing Address            ________________________________________________________________________________

City, State, Zip Code _____________________________________________________________




Please Print All Information Below:


Homeowner or Authorized Person_____________________________________________________

Homeowner Address _______________________________________________________________
City, State, Zip Code _______________________________________________________________

Homeowner Phone _____________________                       Rebate Coupon # ______________________

Signature of Homeowner/Authorized Person___________________________Date___________
(Note: Homeowner/Authorized Person must sign both sides of this form if rebate payment is assigned to
contractor.)

								
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