Rebuild Rebate Form Preview Rebate Form OHIO VALLEY GAS CORPORATION APPLICATION FOR RESIDENTIAL/SMALL COMMERCIAL INCENTIVE(S) Name Name First Name First Name Last Name Last Name PHONE NO. Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip 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. CUSTOMER'S SIGNATURE signature keyboard Clear Date Submit If you are human, leave this field blank.
