2022 Residential rebate application

1 Nicor Gas Residential rebate application | 1123211 of 5 Get ready:Review the eligibility requirements and terms and conditions to verify that you are eligible for a rebate . Collect all required information to complete your started:All applications must be postmarked within 90 days of installation or by January 31, 2023, whichever comes first. Complete, sign and mail the application and invoice and other supporting documents to: Nicor GasAttn: Energy Efficiency 22-59061 Box 540071El Paso, TX 88554-0071 Get your rebate :You will receive the rebate in approximately six to eight weeks when a completed application and the required documents are received for a rebate qualifying product.

2 To check the status of your rebate , visit Need help? Call us at (Mon. Fri., 8 to 5 ) or email Applicant name (print)Applicant signatureDate XApplicant signatureContractor business name (as it appears on invoice or receipt)Phone numberEmail addressAddressStateZIP codeCity XContractor informationFirst nameLast namePhone numberEmail addressInstallation addressCityStateZIP codeNicor Gas account numberPlease write the first 10 digits of your account number. Include any leading zeros but do not include dashes. XCustomer information (as it appears on account) rebates are available for qualifying products purchased and installed between January 1, 2022 and December 31, 2022.

3 Complete all fields on the application , sign and submit with supporting Residentialrebate applicationMailing address (if different than above)CityStateZIP codeMake rebate payable to (select one):Account holderContractor Circle installing member ID number Landlord (check payment only)(required if landlord is selected)First nameLast name XRebate payment optionsCheckPrepaid Mastercard Virtual Account (email required)Prepaid Mastercard (delivered by mail)Method: If you are only requesting a rebate for a self-installed smart thermostat, write "self-installed" in the Contractor Information section below and check "I installed the thermostat myself" in the smart thermostat section on page my signature below, I hereby certify that: 1.

4 The participant has not/will not receive a rebate for the same product, with the exception of qualifying joint ComEd/Nicor Gas rebate The energy-efficient product was paid for as reflected on the invoice, is installed and is The information contained in this application is accurate and All rules of this rebate program have been followed. Equipment/service has met all product eligibility requirements and the terms and conditions within this I have read and understand the terms and conditions included within this I understand that rebates are based upon eligibility and verification of information provided in this application and supporting documents, and is subject to funding Gas Residential rebate application | 1123212 of 5 Provide the following information for the equipment installed (as listed on invoice).

5 Verify your invoice/receipt is legible and includes all the information listed on page three. If any information is illegible or missing, contact your contractor to get the correct information before submitting your application . If you are applying for more than one furnace, boiler, combination boiler or tankless water heater, print and complete additional copies of this page (smart thermostats are excluded).What did you install?Eligibility requirements The rebate amount is determined by the Annual Fuel Utilization Efficiency (AFUE) rating of the qualifying furnace.

6 $225 97% AFUE furnace$200 95% AFUE furnace XFurnaceRebateCheck one:Install dateModel numberManufacturerProduct informationProvide the following information for the furnace installed (as listed on invoice):$25 Smart thermostatLimit one per account XSmart thermostatRebateCheck one:Install dateModel numberManufacturerProduct informationProvide the following information for the smart thermostat installed:Eligibility requirements Limit: One (1) Nicor Gas rebate per household or account. The thermostat must be installed on a system with Residential -sized natural gas space heating equipment with an input capacity of < 300 MBTUH.

7 * Only smart thermostats approved by the Nicor Gas Energy Efficiency Program are eligible for a rebate . For a list of qualifying smart thermostats, visit Smart thermostats must be installed in a home with a working Wi-Fi connection Smart thermostats replacing programmable thermostats qualify for the smart thermostat rebate . An additional rebate may be available from your electric utility. Contact your electric provider for numberSerial numberI installed the thermostat myself* MBTUH = Thousand British Thermal Units per HourFurnaceType of existing natural gas heating system:BoilerWhat did the thermostat replace?

8 Programmable thermostat, set to programProgrammable thermostat, set to "hold"Manual thermostatNicor Gas Residential rebate application | 1123213 of 5$350$500$150 95% AFUE boilerBoiler and integrated domestic hot waterTankless water heater Eligibility requirementsEligibility requirementsEligibility requirements Only Residential -sized boilers with an input capacity of < 300 MBTUH* are eligible. Only Residential -sized boilers with an input capacity of < 300 MBTUH* are eligible. Minimum boiler efficiency for eligible new equipment is 95% AFUE.

9 The combination boiler must have a sealed combustion unit and be capable of modulating the firing rate and must be accompanied by a programmed outdoor reset control. Measures that do not qualify for this incentive include boilers with a storage tank and redundant or backup boilers. Only Residential gas tankless water heaters 75 MBTUH* are eligible. Must meet UEF .87. Must meet ENERGY STAR standards. Tankless water heater must be a whole home unit. XBoiler XCombination boiler XTankless water heaterRebateRebateRebateCheck one:Check one:Check one:Install dateModel numberManufacturerInstall dateModel numberManufacturerInstall dateModel numberManufacturerProduct informationProduct informationProduct informationProvide the following information for the boiler installed (as listed on invoice): Provide the following information for the combination boiler installed (as listed on invoice).

10 Provide the following information for the tankless water heater installed (as listed on invoice): * MBTUH = Thousand British Thermal Units per Hour UEF = Uniform Energy FactorSerial numberSerial numberSerial numberTotal installed cost (per combi boiler) Total installed cost (water heater) Input capacity (MBTUH*)Nicor Gas Residential rebate application | 1123214 of 5 Don't forget to submit a legible copy of the itemized invoice/receipt which must include: XAttach invoice or receiptType of equipment, manufacturer, model and serial numberDate installed and operational (clearly labeled)Total cost of installation (itemized for each rebate qualifying product)Proof of payment or payment terms ( , balance due of zero, financing terms or paid-in-full stamp)For Contractor Circle installing members providing the rebate as an instant discount.