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Ready to Submit?
Include a copy of all documentation required for your rebate.
q Contractor Invoice or Proof of Purchase Receipt, that
includes the equipment model and serial number
q If leasing equipment, a copy of your lease agreement
energySMART Rebate Program
q If rebate payment is being released to the contractor, the
Energy Conservation Program Assignment of Rebate
Form completed in full and signed by the customer
Thank you for your interest in energy efficient appliance rebates!
Complete this rebate application and submit with all required documentation, as
listed to the right. All fields are required unless otherwise noted.
Additional requirements apply for all rebates, as listed on the program Terms and
Conditions document (available for download on the Florida City Gas website).
CUSTOMER AND INSTALLATION INFORMATION
Florida City Gas Account Number
Account Holder First Name
Installation Address
City
q Single Family Home
q Condo
Mail to:
Florida City Gas Rebates Offer
3800 Watt Avenue, Suite 105
Sacramento, CA 95821-2672
Questions?
Please call 888.248.9427 (option 3)
Account Holder Last Name
State
q Apartment
q Duplex
Zip
Phone
q Mobile Home
Premise Type
Email Address
Which natural gas products are currently installed in your home? (Optional)
q Range/Stove
q Water heater
q Furnace/Boiler
q Clothes Dryer
q Generator
q Grill
q Outdoor lighting
q Patio Heater
q Pool Heater
q Gas Fireplace
q Propane water heater
q Propane range
q Propane dryer
q Propane furnace
Select any non-gas appliances replaced (if applicable):
q Electric water heater
q Electric heat pump
q Electric range
q Electric air conditioner
q Electric dryer
q Electric residential heat
SERVICE CONTRACTOR INFORMATION*
Contractor Name
Phone Number
License Number
* If the equipment was self-installed please provide a self-installation waiver to qualify for rebates
REBATE PAYMENT AND MAILING ADDRESS:
Landlord Name (If payee is landlord)
Select Rebate Payee: q Customer q Installing Contractor** q Landlord
Mailing Address
City
State
Zip
** For rebate payments being released to the installing contractor, a completed and customer-signed Energy Conservation Program Assignment of Rebate Form must be provided with this application.
CUSTOMER SIGNATURE: By signing and submitting this rebate application, the customer agrees to the program terms and conditions.
Customer Signature
Print Name
Date
PRODUCT INFORMATION: Complete all fields for the rebate you are applying for. Proof of purchase/lease and installation are required for all equipment.
If you are replacing electric equipment with natural gas equipment or are converting to natural gas from propane, please include product information on page 2.
Please choose the store where you bought your equipment:
q Appliance Direct
q Best Buy
q BranG6Part
q HHGregg
q Home Depot
q Jetson Appliances
q Lowes
q Sears
q Other
Replace Your Natural Gas Appliance - Gas to Gas Replacement
Gas Appliance
Rebate
Tank Water Heater
$350
High-Efficiency Tank
Water Heater (0.63 EF)
$400
Tankless Water Heater
$550
Furnace
$500
Cooking (Gas Range)
$100
Clothes Drying
$100
Manufacturer (Brand) Name
Model Number
Serial Number
Purchase Date
Installation Cost
Switch to Natural Gas Appliances - Electric to Gas Conversion Rebates
Gas Appliance
Rebate
Tank Water Heater
$500
High-Efficiency Tank
Water Heater (0.63 EF)
$550
Tankless Water Heater
$675
Furnace
$725
Cooking (Gas Range)
$200
Clothes Drying
$150
Space Conditioning
Manufacturer (Brand) Name
Model Number
Serial Number
Purchase Date
Installation Cost
$1,200
Please Note: Supporting documentation that clearly indicates the conversion took place or that electric equipment was replaced is required to qualify for the Electric to Gas Conversion rebates.
Switch to Natural Gas Appliances - Propane to Gas Conversion Rebates
Gas Appliance
Rebate
Tank Water Heater
$100
High-Efficiency Tank
Water Heater (0.63 EF)
$400
Tankless Water Heater
$100
Furnace
$200
Cooking (Gas Range)
$25
Clothes Drying
$50
Manufacturer (Brand) Name
Model Number
Serial Number
Purchase Date
Installation Cost
Please Note: Supporting documentation that clearly indicates the conversion took place is required to qualify for the Propane to Gas Conversion rebates.
New Construction - Rebates for Natural Gas Appliances Installed in Newly Constructed Homes
Gas Appliance
Rebate
Tank Water Heater
$350
High-Efficiency Tank
Water Heater (0.63 EF)
$400
Tankless Water Heater
$550
Furnace
$500
Cooking (Gas Range)
$150
Clothes Drying
$100
Manufacturer (Brand) Name
Model Number
Serial Number
Purchase Date
EXISTING EQUIPMENT INFORMATION: Please provide information about equipment that was replaced (Optional)
Appliance Type
Fuel Source
q Electric
q Natural Gas
q Propane
q Electric
q Natural Gas
q Propane
q Electric
q Natural Gas
q Propane
Manufacturer (Brand) Name
Model Number
Serial Number
Installation Cost