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2. MARIETTA POWER AND WATER ENERGY EFFICIENCY REBATE APPLICATION

   Rebates are limited to single-family, residential customers receiving permanent electric service from Marietta Power and Water (MP&W). Rebates shall be a credit applied to the customer's MP&W bill.  

4. Rebate eligibility checklist

   1. I am a residential customer receiving permanent electric service from MP&W.
   2. I am submitting this application within 60 days of purchase.
8. CUSTOMER AND LOCATION INFORMATION
10. Billing Account Number *

    Marietta P&W account number omitting the leading zeros.

12. First Name*

    Name on Marietta P&W account

13. Last Name*
15. Email Address*
16. Daytime Phone Number*

    (999) 999-9999

18. Service Street Address*

    MP&W service address

19. Zip Code*
23. REBATE AND PURCHASE INFORMATION
25. HVAC EQUIPMENT

    1. Conversion from gas to ENERGY STAR® electric or dual fuel heat pump: $250

    1. Conversion to ENERGY STAR® electric central AC unit or heat pump from electric central AC or heat pump: $100

    1. New home installation of an ENERGY STAR® electric central AC unit or heat pump: $150
27. APPLIANCES and OTHER EQUIPMENT

    Please select all applicable appliances or equipment.

    1. ENERGY STAR Freezer®: $25
    2. ENERGY STAR® Room Air Conditioner: $30
    3. ENERGY STAR® Dishwasher: $50
    4. ENERGY STAR® Clothes Washer: $50

    1. ENERGY STAR® Full size refrigerator/freezer: $50*
    2. ENERGY STAR® Heat Pump Water Heater: $250
    3. Programmable thermostat: $30
    4. Water heater blanket: $10

29. *Refrigerator must be >=7.75 cubic feet.  Old refrigerator must be removed. 

31. Upload receipt #1*

    Receipt(s) may show purchase of more than one rebate item.

32. Upload receipt #2
33. Upload receipt #3
34. Upload receipt #4
36. Upload Energy Guide Tag #1
37. Upload Energy Guide Tag #2
38. Upload Energy Guide Tag #3
39. Upload Energy Guide Tag #4
41. Conditions and Requirements
    • The appliance/equipment must be installed in permanent, single-family residence receiving permanent electrical service from MP&W.
    • All appliances must be ENERGY STAR® certified. An Energy Guide tag must be submitted for each appliance.  The Energy Guide must include the ENERGY STAR® logo to confirm the appliance is ENERGY STAR® certified.  Appliances whose Energy guide tags do not have the ENERGY STAR® logo do not qualify for this offer.
    • Receipt(s) and Energy Guide tag(s) must be submitted, along with this completed application, within 60 days of purchase.  
    • Only one item in each category will qualify for the rebate, i.e., if you purchase two refrigerators, you will only receive a rebate for one; if you purchase both a qualifying refrigerator and dishwasher, you will receive a rebate for both.
    • Only one rebate application will be accepted for each category per customer and location for the life of the rebate program.
    • Customer is responsible for securing contractor(s) for HVAC installations.
    • A representative from MP&W may verify installation.
    • Energy Efficiency Rebates cannot be combined with any other MP&W rebates.
    • Rebate program is subject to funding limitations and may end at any time without notice.
    • Please allow eight weeks for credit to be issued to MP&W utility bill.
      

43. I hereby certify that the appliance/equipment/improvements have been installed at the address above and I will allow a representative from MP&W to physically inspect my residence if requested. I certify by my signature below that I will comply with all the requirements of the rebate program, and further acknowledge that providing any false information may subject me to criminal penalties under O.C.G.A section 16-10-20 up to and including a fine of $1,000 and imprisonment for five years. 

45. Applicant's signature *
46. Date of signature*
Leave This Blank:


48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit

* indicates a required field