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RESIDENTIAL

COOLING & HEAT PUMP WATER HEATERS

Promotion Dates: 06/01/2012 - 05/31/2013 Requests must be postmarked by 06/30/2013.

Funds are limited, and UGI Utilities reserves the right at any time to extend, modify or terminate the rebate program.

To receive your UGI Utilities Visa Prepaid Card by mail, follow these steps:
1) Purchase a Qualifying Product during the promotion dates listed above. Must be installed in a residential property within UGIs electric service territory. 2) Mail the following to the address on right (1 application per unique qualifying product):

This signed and dated application with all information completed accurately and legibly. A copy of the first page of your most recent UGI Utility bill. A copy of your itemized receipt/invoice reflecting the retailer name, purchase and/or

install date, description, manufacturer, model, purchase price and proof of payment.

A copy of the AHRI certificate. Please visit www.ahridirectory.org or ask your contractor to provide this.
3) IMPORTANT: Photocopy your entire submission for your records.
QUALIFYING PRODUCT DATE INSTALLED MANUFACTURER MODEL #

UGI Utilities Rebates Offer # H044891 PO Box 130002 El Paso, TX 88513-0002


SEER EER REBATE

COOLING CAPACITY

Central Air Conditioner

SEER 14.5 SEER 15+

_____/______/________ _____/______/________

$150
Existing equipment is in working condition? Yes No

(Cooling Capacity < 5.4 tons)

Replaces existing equipment? Yes No

QUALIFYING PRODUCT

DATE INSTALLED

MANUFACTURER

MODEL #

COOLING/HEATING SEER CAPACITY


_________/__________ _________/__________ _________/__________

EER

HSPF

REBATE

$225

Air-Source Heat Pump


(Cooling Capacity < 5.4 tons)

SEER 14.5 SEER 15

_____/______/________ _____/______/________

$250 $325 $400


ENERGY FACTOR

SEER 16 _____/______/________ Replaces existing equipment? Yes No


DATE INSTALLED
_____/______/________

Existing equipment is in working condition? Yes No

QUALIFYING PRODUCT

MANUFACTURER

MODEL #

CAPACITY
(GALLONS)

REBATE

EF > 2.0 Heat Pump Hot or COP > 2.0 Water Heater CUSTOMER INFORMATION
ENERGY STAR

Replaces existing equipment? Yes No

Existing equipment is in working condition? Yes No

$300
*Denotes Required Fields

*UGI Utilities Account #


*First Name

Business Name

_____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____

*Last Name

*Mailing Address (Your Visa Prepaid Card will be mailed to the address provided in this field.) *City Email (Used to send status updates regarding this application.) *State *Zip Code Phone

If you are a business, please indicate your Tax Status:

Sole-Proprietor

Partnership

Government

Non-Profit

Corporation

Religious

SSN or Fed. Tax ID: _______________________________________________ How did you hear about UGI Utilities' rebates? UGI Bill Insert

Legal Name: ______________________________________________________________ Newspaper Television Internet Store Other

Prepaid Cards will be mailed to qualifying customers within 60 days of the postmark date on your request. To review the status of your application or to ask questions, call 1-855-300-3792 or visit www.smartenergy-zone.com/UGI at any time. Your right to receive this rebate will not be earned unless you purchase a qualifying product and follow each of the steps above. This rebate cannot be combined with any other UGI Utilities rebate, unless specified in writing by UGI Utilities. One rebate per Electric Account Number for Air Source Heat Pump or Central Air Conditioning System. All rebated Heat Pump Hot Water Heaters must be ENERGY STAR qualified, listed with and certified by the Air Conditioning, Heating, and Refrigeration Institute (AHRI), and meet the program SEER, EER and HSPF requirements (see table on page 1). The A/C condenser and the evaporative coil must be new and replaced together. The condenser and coil are separate components in a split A/C or heat pump system, but for rebate purposes, are considered one unit. This rebate is available to UGI Utilities customers with mailing addresses in the United States. UGI Utilities is not responsible for lost, late, damaged, illegible, misdirected or postage-due applications. Your rights to this rebate cannot be assigned or transferred. Excessive submissions constitute fraud and may result in federal prosecution under the U.S. mail fraud statutes (Title 18, USC 1341 and 1342). All submitted materials become property of UGI Utilities and will not be returned. Prepaid Cards are issued by Citibank, N.A. pursuant to a license from Visa U.S.A. Inc. and managed by Citi Prepaid Services. Cards will not have cash access and can be used everywhere Visa debit cards are accepted. Card will expire 6 months from the issuance date. I accept the Terms of this rebate appliaction and understand UGI Utilities reserves the right to audit my application and if requested, I will allow UGI representatives reasonable access to verify the installation of qualifying product(s) and potentially the removal of older products. UGI Utilities may provide my name and address to UGI representatives to verify this information and I approve sending the rebate to the address I have provided above.

TERMS & CONDITIONS

ACCEPTANCE OF TERMS

*Customer Signature:

Date: _______________________________

x ___________________________________________________________________________
H044891 (UAG)

UGI Utilities Residential Cooling & Heat Pump Water Heaters Rebate