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THE UTILITIES BOARD OF THE CITY OF ONEONTA LIGHT - OPEN FLAME OR 2-MANTLE REBATE PROGRAM

Thank you for choosing natural . To receive your rebate, you and your contractor must complete this form. This form must be accompanied with a copy of a receipt or invoice for your natural gas light and a receipt or work order for installation from your contractor. Take the preceding items to the Utilities Board office at 105 High School Street. Office hours are Monday through Friday, 8 a.m. to 4:30 p.m. Shortly after returning this form, physical verification of installed gas lighting may be required. If so, a Utilities Board representative will contact you.

I REQUEST A REBATE IN THE AMOUNT OF $50.00 FROM THE UTILITIES BOARD OF THE CITY OF ONEONTA FOR THE PURCHASE OF A NEW NATURAL GAS LIGHT . I CONFIRM THAT I HAVE PURCHASED A NEW NATURAL GAS LIGHT AND IT HAS BEEN INSTALLED AT THE ADDRESS SPECIFIED BELOW.

Customer Information

Customer Name: Customer Signature:

Date: Phone #

Mailing Address: Service Address:

City/State/ZIP: City/State/ZIP:

Contractor Information Account Number

Application Number

Appliance Installing Contractor's Name: Service Line Number

Check Number

Contractor's Signature: Date of Check

Installation Verified By Phone Number: Alabama Gasfitter Certification #: The Utilities Board of the City of Oneonta

Natural Gas Light Rebate Terms and Conditions

1) The gas light you are requesting a rebate for must be a new natural gas gas light and not originally a liquefied gas light that has been converted or modified to utilize natural gas.

2) The gas light must be installed by a State of Alabama Certified Natural Gas Fitter in accordance with the International Gas Code.

3) The rebate form must be completed by you and your installing contractor.

4) You must include with the rebate form a receipt for the purchase of the gas light and an installation receipt from the contractor that installed the gas light.

5) The Utilities Board of the City of Oneonta may require a physical verification of the gas light installation. If so, a Utilities Board representative will contact you to set up a meeting at the location of the installed gas light.

By signing below you acknowledge and confirm that you have read and accept the terms and conditions for this rebate.

Customer Signature Date

Checklist Before Coming to Utilities Board's Office: 1) Completed Gas Light Rebate Form 2) Signed Gas Light Rebate Terms & Conditions 3) Appliance Receipt 4) Contractor/gas fitter receipt for installation 5) Valid Identification: Driver's License 6) Social Security Card