draft rebate form

Delete when done Rebate Form

FORM #203
REVISED 02/24

OHIO VALLEY GAS CORPORATION APPLICATION FOR RESIDENTIAL/SMALL COMMERCIAL INCENTIVE(S)

Address
Address
City
State/Province
Zip

 

Applicant must complete and submit this Reservation Application form to cover the planned INSTALLATION or CONVERSION of a HEATING OR WATER HEATING SYSTEM or other natural gas-fired equipment at the above address. Upon completion of the installation or conversion, which must occur within 60 DAYS after application for incentive is approved, the applicant must re-submit the approved Reservation Application form along with applicable receipts and documentation covering the equipment used for the installation or conversion.

RESERVATION FOR INCENTIVE

I/We hereby apply for an incentive reservation to cover our planned installation/conversion of the following natural gas appliance(s) in the residential home located at the above service address.

FURNACE (90% EFFICIENT OR GREATER)

FURNACE (90% EFFICIENT OR GREATER)

New
Converted From
Piping

FURNACE (80–89% EFFICIENT)

FURNACE (80–89% EFFICIENT)

New
Converted From
Piping

SPACE HEATER (30,000 BTU AND UP)

SPACE HEATER (30,000 BTU AND UP)

New
Converted From
Piping

CONVERSION OF EXISTING FURNACE

CONVERSION OF EXISTING FURNACE

New
Converted From
Piping

FIREPLACE/GAS LOG SET

FIREPLACE/GAS LOG SET

New
Converted From
Piping

WATER HEATER – (ENERGY FACTOR 0.82 OR GREATER)

WATER HEATER – (ENERGY FACTOR 0.82 OR GREATER)

New
Converted From
Piping

WATER HEATER – (ENERGY FACTOR 0.64–0.81)

WATER HEATER – (ENERGY FACTOR 0.64–0.81)

New
Converted From
Piping

WATER HEATER – (ENERGY FACTOR 0.63 OR LESS)

WATER HEATER – (ENERGY FACTOR 0.63 OR LESS)

New
Converted From
Piping

SWIMMING POOL HEATER

SWIMMING POOL HEATER

New
Converted From
Piping

CLOTHES DRYER

CLOTHES DRYER

New
Converted From
Piping

KITCHEN RANGE (COOK-TOP AND OVEN)

KITCHEN RANGE (COOK-TOP AND OVEN)

New
Converted From
Piping

 

WE HEREBY APPROVE YOUR RESERVATION APPLICATION FOR AN INCENTIVE IN THE TOTAL AMOUNT OF

$

 

THIS AMOUNT HAS BEEN COMPLETED, CONTACT US AND REQUEST AN EXTENSION OR THIS APPLICATION FOR INCENTIVE WILL BE VOIDED ON (DATE):

Date:

Coporate Office

765-584-6842

111 Energy Park Drive, Winchester, IN 47394

Hours, M-F: 7am-4pm

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