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: FCG-Rebates@nee.com

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: