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2015 Heat and Hot Water Conversion
Early Bird Service Agreement Incentive
INSTRUCTIONS: To apply for your incentive, please fill out this application form completely, truthfully and accurately and mail it with a copy
of the completed Residential Natural Gas Installation Agreement dated within the timeframe specified in the eligibility section above and a copy
of their first CNG or SCG gas bill to:
EFI – CT Residential Natural Gas Conversion Incentive
40 Washington Street, Suite 2000
Westborough, MA 01581
ELIGIBILITY:
This $250 incentive is valid for prospects of the Walter Hamden project and who sign a Residential Natural Gas Installation
Agreement between March 23 and April 21, 2015 and who meet the terms and conditions of the Natural Gas Installation
Agreement. Applicants must submit a copy of the dated Agreement with this rebate form and a copy of their first CNG or SCG gas bill
and it must be postmarked on or before January 31, 2016. Only Southern Connecticut Gas Company (SCG) or Connecticut Natural Gas
Corporation (CNG) new residential natural gas heat and hot water conversion customers are eligible. This incentive may be subject to
change without prior notice. SCG and CNG reserve the right to conduct field inspections to verify conversion installations.
CUSTOMER INFORMATION
First Name (please print)
Last Name
Address
City / State / Zip
Home Phone
Cell Phone
Email Address
TERMS & CONDITIONS
APPLICATION: To apply for your incentive, this form must be filled
out completely, truthfully and accurately. The customer must
submit this completed incentive application along with a copy of
the completed Residential Natural Gas Installation Agreement
dated within the timeframe specified in the eligibility section
above and a copy of their first CNG or SCG gas bill. Limit: One
incentive per residential natural gas account in the SCG or CNG
service territory.
PAYMENT: Payment is processed after the customer has received
their first natural gas bill. Please allow up to 90 days for payment.
Payment may take longer if information is missing on the incentive
application. SCG customers may call: (203) 795-7609 and CNG
customers may call: (860) 727-3246 with any questions or to
inquire about the status of your incentive application.
TAX LIABILITY: SCG and CNG will not be responsible for any
tax liability that may be imposed on the customer as a result
of the payment of the incentive.
LIMITATION OF LIABILITY: SCG and CNG’s liability is limited to
paying the qualifying incentive specified. SCG and CNG are not
liable for any damages arising out of or resulting from
participation in this incentive offer, including but not limited
to loss of profits, loss of revenues, failure to realize expected
savings, loss of data, loss of business opportunity, or similar
losses of any kind, as well as any indirect, incidental, punitive,
special, or consequential damages, or for any damages in tort
connected with or resulting from participation in this program.
Incentive application cannot be reproduced, photocopied or
altered in any way.
APPROVAL AND VERIFICATION: SCG and CNG reserve the right to
verify transaction and to have reasonable access to your residence
to inspect the equipment/system installed under this program
prior to issuing incentives, for up to one year after date of
incentive application.
By signing this application form below, I certify that I am a new residential natural gas heat and hot water conversion customer. I also
certify that I reside at the address indicated above located within the SCG or CNG service area. I also understand that the $250
Conversion Contract Signature Incentive only pertains if the ELIGIBILITY and TERMS & CONDITIONS requirements are met. Completion
of this application is in no way a guarantee of receipt of this incentive. Customers are encouraged to make a copy of this completed
form for their records.
Customer Signature
Date
G0133 Rev. 1/15