8/9/2019 CO Bus Lighting Redesign Study Rebate App
1/2
APPLICATION
COLORADO
Lighting EfficiencyLIGHTING REDESIGN STUDY REBATE
APPLICATION
PAGE 1 OF 2 10-12-541 | 12/2010 | CRS 1922
Customer name
_______________________________________________________________________
Date submitted _______________________
Billing address _____________________________________ City
_______________________________ State ________ ZIP
___________________
Building address (if different) _________________________ City
_______________________________ State ________ ZIP
___________________
Xcel Energy premise number (Elec)
Customer contact person (print)
__________________________________________________________ Title
________________________________
Phone ___________________________________________Fax
____________________________________________________________________
Customer Contact e-mail*
_______________________________________________________________
Customer contact person signature
_______________________________________________________ Date
_______________________________
* By providing your e-mail address, you are granting Xcel Energy
permission to send further e-mails regarding our programs and
services.
Customer hereby certifies that: 1.The customer, and not Xcel
Energy, is solely responsible for the accuracy of the information
contained in thisapplication; 2.The study is complete and the
report has been presented prior to submitting the rebate; 3.The
customer is satisfied with the results of
the report; 4.The customer will pay the engineering firm
directly for the full cost of the study; and 5.All rules of this
Xcel Energy program have beenfollowed. Further, the customer
acknowledges that participation in this rebate program shall impose
no liability on Xcel Energy. In particular,
Xcel Energy shall not be liable for the work performed by the
customers engineer, contractor or vendor.
Alternate Rebate Recipient
Company name
___________________________________________________________________________________________________________
Contact name
______________________________________________________________
Phone ________________________________________
Address __________________________________________ City
_____________________ State _______________ ZIP
_____________________
Contact person
_______________________________________________________________________
E-mail* _____________________________* By providing your e-mail
address, you are granting Xcel Energy permission to send further
e-mails regarding our programs and services.
Customer Information
Lighting Consultant Information
INTERNAL USE ONLY PLEASE DO NO WRITE IN THIS SPACE
Xcel Energy Account Manager (signature)
_____________________________________ Date
______________________________
Xcel Energy authorized signature
____________________________________________ Date
______________________________
Total Study rebate amount $ ________________
