Piedmont Natural Gas Rebate Application Form – Fill Out and Use This PDF

TERMS AND CONDITIONS

Energy Efficient Equipment Rebate Program (North Carolina)

Rebate Program Duration: This Rebate Program begins March 23, 2009, the date on which it was approved by the North Carolina Utilities Commission. Piedmont Natural Gas Company, Inc. (Piedmont) reserves the right to modify, withdraw or terminate this Program at any time, and such decision will be posted on the Piedmont website on or before the date of such modification, withdrawal or termination. Please visit www.piedmontng.com.

Website: Details of this Rebate Program, including Rebate amounts, dates of the Rebate Program, eligibility, qualifications and application process are subject to change without prior notice. Prior to submission of a Rebate Application, it is the sole responsibility of the customer to timely verify all information on Piedmont’s website at www.piedmontng.com. The Terms and Conditions listed herein are supplemental to terms, conditions and other information listed about this Rebate Program on the Piedmont website and must be read in conjunction with such. The Piedmont website, the Rebate Application and these Terms and Conditions together constitute the entire Rebate Program. If you have further questions, you may call Piedmont at 1-877-279-3636.

Eligibility: This Program is only available to current Piedmont residential and commercial customers in North Carolina having natural gas service accounts in good standing. Rebate is available solely for the qualified new equipment listed on the Rebate Application, purchased and installed during the Rebate Period and prior to customer’s submission of the Rebate Application. Rebates qualify only on such new equipment installed for replacement, in remodeling or renovation, not in new construction; and only where 1) existing gas-serviced equipment is being replaced by new gas-serviced equipment, 2) such new equipment qualifies for the higher efficiency rating set forth on the Application Form, 3) the new equipment is installed at the house or business where the gas account is located, and 4) the new equipment is purchased from and installed by a licensed contractor. Final determination of eligibility will rest solely with Piedmont. Residential customers: maximum number of rebates per residential service address is 2 rebates in a 12-month period for water heating and 2 rebates in a 12-month period for space heating; each applicant is limited to receiving no more than a total of 24 rebates in a 12-month period. Commercial customers: maximum number of rebates per commercial service address is 4 rebates in a 12-month period and each applicant is limited to receiving no more than a total of 36 rebates in a 12-month period.

Application: The Rebate Application on Piedmont’s website must be 1) printed out, 2) completed truthfully and legibly, in its entirety, 3) signed by the individual in whose name the Piedmont account is listed, 4) attached to a copy of the legible, dated, itemized and detailed proof of purchase (receipt), and to a copy of the legible, dated, itemized and detailed proof of installation (receipt, installation contract, or contractor invoice), and 5) mailed with adequate postage to the address listed on the Application. If multiple qualified purchases are listed on the same receipt, please include a fully completed Rebate Application and supporting documentation in one envelope. All Applications must be postmarked during the Rebate Period set forth on Piedmont’s website, and within 90 days after the equipment installation. Piedmont is not responsible for lost, late, damaged or misdirected forms. Late, illegible or incomplete forms will not be processed. All Applications become the sole property of Piedmont. No Application, including attachments, will be returned to the customer. Do not include a Rebate Application with payment of your monthly Piedmont bill. The Application, with qualifying attachments, must be submitted separately.

Verification: Piedmont reserves the right to verify sales receipts, serial numbers, installation contracts, and all other documentation and processes incidental to this Application. Also, an inspection may be conducted to verify installation of qualified equipment at qualified locations. By submitting this Application, customer agrees to participate in any audit and/or inspection requested by Piedmont related to this Rebate Program. Piedmont, or a third-party acting as their agent, may conduct a survey and/or billing energy usage analysis to measure program impact savings and participant satisfaction.

Payment: Funds approved by the North Carolina Utilities Commission for this Rebate Program are limited and available on a first-come, first-served basis. Rebates shall be in the qualified amount listed on Piedmont’s website on the postmarked date of the Application submission. As soon as practicable after receipt and processing of the completed Rebate Application, the Rebate Check will be mailed to the individual or entity listed on the Application, verified to be the Piedmont customer at the address where gas service is supplied and the new equipment has been installed. Piedmont is not responsible for any tax liability imposed on the customer as a result of payment of this Rebate.

No Endorsement, warranty or liability: By promotion and offer of this Rebate for purchase and installation of specific energy efficient equipment, Piedmont does not endorse any manufacturer, contractor, product or system, or in any way warranty such equipment, installation, or the energy efficiency of any equipment. Piedmont makes no representation and has no responsibility regarding the equipment, its installation, its energy efficiency; or any compliance of the equipment or its installation with applicable laws, regulations, codes, standards or requirements. Further, Piedmont shall in no way be liable for any incidental or consequential damages resulting from the equipment or its installation.