Piedmont Natural Gas Rebate Application Form PDF Details

For residents and commercial entities in North Carolina seeking to upgrade to more energy-efficient equipment, the Piedmont Natural Gas Rebate Application form presents a valuable opportunity to save money while enhancing their environmental impact. As part of a generous initiative that began on March 23, 2009, following approval by the North Carolina Utilities Commission, this program offers financial rebates for the installation of qualifying energy-efficient natural gas equipment, namely water heaters, furnaces, and tankless water heaters. Essential for applicants is the provision of detailed customer and equipment information, including account numbers, installation details, and product specifications, to ensure eligibility. Rebates, which differ in amount based on the type of equipment installed, are contingent upon meeting specific energy efficiency criteria and require the installation to be performed by a licensed contractor. Furthermore, applicants must complete and submit the form, alongside the necessary purchase and installation proof, within 90 days of installation—a stipulation underscored by stringent terms and conditions that govern the program. This carefully structured program reflects Piedmont Natural Gas Company, Inc.'s commitment to promoting energy efficiency within its service areas, providing both immediate financial benefits to its customers and contributing to broader environmental sustainability goals.

QuestionAnswer
Form NamePiedmont Natural Gas Rebate Application Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namespiedmont application natural, piedmont equipment program search, piedmont water rebates, piedmont gas rebate form

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Rebate Application Form (North Carolina Customers)

Energy Efficient Equipment / Water Heater, Furnace

REQUIRED CUSTOMER INFORMATION

Account Number

Name on Account* ____________________________________________ Phone ( ) _____________

Service Address ________________________________________________________________________

City _____________________________________________, North Carolina Zip _________________

* Rebate checks will only be issued in the name on the service account

Email Address (optional) ____________________________________________________________________________

Mail my rebate to Mailing Address_______________________________________________________

a different address: City _______________________________ State ___________ Zip___________

How did you hear about the program? Utility bill insert Contractor Piedmont Website Newspaper Other ______________

REQUIRED EQUIPMENT INFORMATION

RESIDENTIAL Customers are eligible for all Rebates. COMMERCIAL Customers are eligible only for Tankless Water Heater Rebate.

All applications must be postmarked within 90-days of the equipment installed date.

Equipment Installed

Installation Contractor Information

 

Date

Quantity

 

Rebate

 

Installed

Installed

 

Amount

 

 

 

 

Natural Gas Storage

Contractor Name _________________________________

 

 

 

 

Tank Water Heater

Address ________________________________________

 

 

 

$ 50

Must have a 0.62 Energy

City, State, Zip ___________________________________

_________

______

 

per Unit

Factor or higher

Phone _________________________________________

 

 

 

 

 

 

 

 

 

 

 

New Storage Tank Water Heater Info:

Approximate Age of Old Water Heater

 

Brand of Water Heater ___________________________________ Energy Factor _________

or Old Water Heater Energy Factor _________

Model Number(s) ________________________________________ Serial Number(s) ________________________________________________

Natural Gas

Tankless Water Heater

Must have a 0.82 Energy

Factor or higher

Contractor Name _________________________________

Address ________________________________________

City, State, Zip ___________________________________

Phone _________________________________________

Date

Quantity

Installed

Installed

________

______

 

 

$150

per Unit

New Tankless Water Heater Info:

 

Approximate Age of Old Water Heater

Brand of Water Heater __________________________________

Energy Factor _________

or Old Water Heater Energy Factor _________

Model Number(s) _______________________________________

Serial Number(s) ________________________________________________

 

 

 

 

 

 

Natural Gas Furnace

Must have a 90% Annual Fuel Utilization Efficiency (AFUE) or higher

Contractor Name _________________________________

Address ________________________________________

City, State, Zip ___________________________________

Phone _________________________________________

Date

Quantity

Installed

Installed

_________

______

 

 

$175

per Unit

New High Efficiency Furnace Info:

Approximate Age of Old Furnace

Brand of Furnace _______________________________________________ AFUE _____________

or Old Furnace AFUE ____________

Model Number(s) ___________________________________________ Serial Number(s) _____________________________________________

INSTRUCTIONS AND SIGNATURE

You MUST read ALL of the Terms and Conditions on the following page and as further set forth on the website at www.piedmontng.com

 

 

 

I certify that the information I have provided is true and correct and

 

You MUST include the following for the Rebate to be processed

:

 

the equipment for which I am requesting a rebate meets the

 

1) An original, signed and completed Rebate Application form

 

requirements of this Application and has been installed at the

 

2) Copy of the proof of installation (receipt/invoice/contract)

service address indicated. I understand that in order to receive

 

and/or copy of the proof of purchase (sales receipt)

payment, all information requested on this Application must be

 

3) Provide signature at bottom right

completed and copies of all purchase and installation invoices

 

Mail the completed application to:

attached. I certify that a licensed contractor has installed the above

 

natural gas equipment. I have read and am in compliance with the

 

Piedmont Natural Gas Company, Inc.

 

program guidelines and terms and conditions as described on the

 

Attn: Marketing / NC Rebate Form

Company website.

 

P.O. Box 33068

Customer Signature__________________________________

 

Charlotte, NC 28233

 

 

 

** Please allow up to 6-weeks for rebate processing **

Date _________________________________________________

 

 

 

 

 

5/11

 

 

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.

5/11

Piedmont Natural Gas Rebate Program

 

Effective 3/23/2009