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Builder/Owner Phone Number Social Security/Tax ID
Mailing Address City State Zip Code
Signature (Builder/Owner) Date
B u i l d e r R e b a t e P r o g r a m
Service Address City State Zip Code
Service Subdivision Lot Number Block
Qty. Gas Appliance Allowance Total Allowance
$550
$350
High Efficiency Water Heater
Furnace $500
Dryer $100
Range $150
Additional Incentives
F o r O f f i c e U s e O n l y
Approval Signature Date Rebate Number
Residential Builders & DevelopersNew Construction Energy Conservation Program
B u i l d e r I n f o r m a t i o n
This energy conservation program is designed to encourage builders to install natural gas appliances in their new construction projects. Builders must provide reasonable verification and there must be an active gas account to qualify for the residential new construction energy conservation program. Acceptable verification of new appliance includes the following: appliance make, model and serial number, authorized field employee verification or purchase and installation receipts. Please note ONLY connected appliance are eligible. If you have any questions, call 888.CITY.GAS.
Email this form to: [email protected]
A p p l i a n c e C o u n t
Water Heater
Tankless Water Heater
Make/Model Number Serial Number
$400
Total: