HVAC REBATE PROGRAM APPLICATION - …

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HVAC REBATE PROGRAM APPLICATION . MEMBER INFORMATION. As shown on PEC Bill First Name:___________________________________ _ Last Name:___________________________________ ________________. PEC Account #:______________________________________ ___ Is this a landlord account? Is this a rental property? Installation Street Address:________________________________ ________________________________________ ____________. City:___________________________________ ____________________ State:_______________Zip:_______________ ___________. County:_________________________________ ___________________. PO Box/Mailing Street Address:________________________________ ________________________________________ ________. City:___________________________________ ____________________ State:_______________Zip:_______________ ___________. Primary Phone #:___________________________________ Secondary Phone #:______________________________________ __. Email:__________________________________ ________________________________________ _____________________________.

1/2013 Page 2 HVAC REBATE PROGRAM APPLICATION CONTINUED APPLICANT ACKNOWLEDGEMENT By signing this form, the Member affirms that the information reflected here is accurate to the best of his or her