Heating Equipment for Primary Residence

Rebate Application—Page 1

Apply online by visiting pgwenergysense.com

Promotion Dates: 09/01/2020—08/31/2023

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Other: ____________________

Opt-In I’d like to learn more about PGW’s

EnergySense programs and offers by

email.

How did you hear about PGW rebates? (Circle all that apply)

EnergySense incentives across all projects are capped at $150,000 per customer per year. For proposed rebates above $25,000 at an individual address, contact the EnergySense program at 855-749-7658 to determine eligibility.

Rebate checks will be mailed to qualifying customers within 4-6 weeks of the postmark date on your qualified application. To review the status of your application or to ask questions, call 1-855-749-7658 or visit www.pgwenergysense.com at any time. Your right to receive this rebate will not be earned unless you purchase a qualifying appliance and follow each of the steps above. Your failure to satisfy each of these Conditions of Acceptance is a rejection of this rebate offer. Purchases from online auctions are not eligible. This rebate cannot be combined with any other PGW rebate, unless approved in writing by PGW. Rebates are only available for premises served by PGW Firm natural gas rates. Failure to provide reasonable access to a PGW representative to verify installation of qualifying product(s) may lead to repeal and rescinding of the rebate award and may take any related legal action(s) it deems necessary. This offer is available to PGW customers with mailing addresses in the United States only. Purchases made in or for delivery to other countries are not eligible. PGW is not responsible for lost, late, damaged, illegible, or postage-due applications. Your rights to this rebate cannot be assigned or transferred. Excessive submissions will constitute fraud and may result in federal prosecution under U.S. Mail fraud statutes (Title 18, USC 1341 and 1342). All submitted materials become property of PGW and will not be returned. Rebate paid by check in US Dollars. It is required that you cash the rebate check within 90 days of the issuance date on the check. Rebates are awarded on a first-come, first served basis and are subject to available funds. PGW reserves the right to change and/or end any portion of this program without notice.

*PGW Account #:

*Customer Name:

*Billing Address: *City: *State: *Zip Code:

*Email Phone:

*Installation Address: *City: Philadelphia *State: PA *Zip Code:

*Contractor Name: Contractor Email:

*Contractor Address: *City: *State: *Zip Code:

I understand PGW reserves the right to audit my rebate application and if requested, I will allow PGW representatives reasonable access to verify the installation of qualifying product(s) at the service address listed above.

*Signature:

*Date:

- The billing address for your PGW account is the address where the check will be mailed and your email address will be used to communicate with you about your rebate application.

- Your contractor’s email address will be used to clarify any questions you can’t answer about your application and to communicate updates regarding PGW programs.

(!) IMPORTANT: Photocopy your entire submission for your records. You could be required to mail, e-mail or fax these photocopies.

CUSTOMER INFORMATION

Complete section(s) on back for all units

Qualifying Product Criteria Incentive

Natural Gas Furnace Efficiency Level (AFUE) must be 95% or greater $350 | $250

First | Add’l

Natural Gas Boiler Efficiency Level (AFUE) must be 94% or greater $900 | $700 First | Add’l

Natural Gas Combi Boiler $1,300 | $1,000

First | Add’l

Natural Gas Tankless Water Heater

Must be ENERGY STAR® Certified Minimum required gas pressure ≤ 4.5” w.c

Input Capacity ≤ 150 MBH$350 | $350

To receive your PGW rebate check by mail, follow these steps:

1. Purchase the Qualifying Product(s) within the eligible promotion dates. Equipment should be installed by a licensed contractor. Review the listingsat www.ahridirectory.org, or at www.energystar.gov for Tankless Water Heaters, to ensure your equipment qualifies for this program.

2. Install the product(s) where there is an active meter using PGW services. Account must be eligible at the time of payout to be eligible for therebate.

3. Mail the following to the address below:

a. This rebate form, completed accurately and legibly. Landlord/building owner is responsible to acquire and provide valid PGW account

information for each installed equipment purchase.

b. A legible copy of your itemized invoice that shows retailer/contractor name, address, phone number, invoice date, description,

manufacturer, model, quantity, purchase price and proof of payment.

4. Mail to: PGW EnergySense Rebate Program, 40 West Evergreen Ave. Suite 110, Philadelphia, PA 19118

Visit pgwenergysense.com or call 855-749-7658 for program updates, questions or to track the status of your rebate.

Efficiency Level (AFUE) must be 94% or greater Minimum required gas pressure ≤ 4.5” w.c

Input Capacity ≤ 205 MBH

$700 | $250

$1,225 | $700

$1,800 | $1,000

$625 | $350

First | Add’l

First | Add’l

First | Add’l

To qualify for Affordable EnergySense incentives, within the last year customers must have enrolled in PGW’s CRP program, received a UESF grant, or received a LIHEAP grant and assigned it to PGW. Affordable EnergySense incentives are available for eligible equipment installed on or after 09/1/2021.

*Denotes Required Fields

Afforable EnergySense IncentiveFor qualified customers

First | Add’l First | Add’l

*Denotes Required Fields

Heating Equipment for Primary Residence

Rebate Application—Page 2

Apply online by visiting pgwenergysense.com

Promotion Dates: 09/01/2020—08/31/2023

*Select One First Unit *Manufacturer *Model # *Serial #

Boiler $900

Combi Boiler $1,300

Furnace$350

Tankless Water Heater$350**

*Capacity (kBtu/h) *AHRI Certificate # *AFUE (%)

Additional Units *Manufacturer *Model # *Serial #

Furnace$250

Tankless Water Heater$350**

Boiler $700

Combi Boiler $1,000

*Capacity (kBtu/h) *AHRI Certificate # *AFUE (%)

PR

OD

UC

T - 1

*Select One First Unit *Manufacturer *Model # *Serial #

Boiler $900

Combi Boiler $1,300

Furnace$350

Tankless Water Heater$350**

*Capacity (kBtu/h) *AHRI Certificate # *AFUE (%)

Additional Units *Manufacturer *Model # *Serial #

Furnace$250

Tankless Water Heater$350**

Boiler $700

Combi Boiler $1,000

*Capacity (kBtu/h) *AHRI Certificate # *AFUE (%)

PR

OD

UC

T - 2

*Select One First Unit *Manufacturer *Model # *Serial #

Boiler $900

Combi Boiler $1,300

Furnace$350

Tankless Water Heater$350**

*Capacity (kBtu/h) *AHRI Certificate # *AFUE (%)

Additional Units *Manufacturer *Model # *Serial #

Furnace$250

Tankless Water Heater$350**

Boiler $700

Combi Boiler $1,000

*Capacity (kBtu/h) *AHRI Certificate # *AFUE (%)

PR

OD

UC

T - 3

TOTAL # OF UNITS:______________ | TOTAL REBATE AMOUNT EXPECTED: $____________

**All boilers and furnaces must be AHRI certified.Tankless water heaters must be ENERGY STAR

® Certified, AHRI Certificate # not required

You must complete this page of the application form; use additional pages if needed. Only enter total rebate amount once if more than 4 units were purchased and installed. Eligible products will be combined into one rebate check for payment, pre application submission.

Where applicable, please check the corresponding box to indicate your equipment meets all criteria and you have all the proper documentation to submit with your application:

Does the tankless water heater model have an input capacity (kBtu/h) of 150 MBH or less?

Have you obtained a copy of the tankless water heater model's EnergySTAR® certificate?

Does the combi boiler model have an input capacity (kBtu/h) of 205 MBH or less?

Have you obtained a copy of the AHRI certificate for the furnace, boiler, and or combi boiler models?