2009 For Residential and Commercial Customers

Energy Rewards Rebate Application

OFFICE USE ONLY Payment Release approved by: RFC Date:

Please complete both sides of this application, sign and mail with copies of receipts/invoices to: OFFICE USE ONLY
IID Rebate Processing Center, 81-600 Avenue 58, La Quinta, CA 92253
Only fully-completed applications will be processed.
BUILDING AND ACCOUNT INFORMATION — WHERE ITEMS ARE INSTALLED
 IID Contract Account No. Account Name/Business Name (as it appears on your IID energy bill)
Commercial q Residential: q House q Apt. q Mobile Home
 Installation Address Unit or Apt. No.

 City State Zip Code

APPLICANT information
 Last Name First Name  Daytime Area Code and Phone No.  E-mail Address
 (   )
 Mailing Address City State Zip Code

inspection contact information

 Contact Person   Daytime Area Code and Phone No.  Cell Area Code and Phone No.
 (   )  (   )

landlord/owner *If you are a Landlord/Owner or Commercial customer, please complete this section (this information takes the place of the IRS Form W-9):
Taxpayer ID Number or Social Security Number Tax Status (check one):
q Individual/Sole Prop. q Partnership q Corporation q Exempt

Tax Liability—Rebates and incentives are taxable, and if greater than $600 are reported by IID to the Internal Revenue Service as income to you on Form 1099,
unless you have checked corporation or exempt tax status above. You are urged to consult your tax advisor concerning the taxability of rebates. IID Energy and
Imperial Irrigation District are not responsible for any taxes that may be imposed on your business as a result of your receipt of this rebate.

terms and conditions

1. I understand the program term is through December 31, 2009, or sooner if allocated funds are depleted.
Only purchases made January 1, 2009, through December 31, 2009, qualify for a rebate. Funds are limited
and rebates are not guaranteed. Applications for rebates totaling $2,500 or more require pre-approval
by calling IID Public Programs and all applications are accepted on a first-come, first-served basis. This
program may be modified or terminated without prior notice.
2. I understand the item(s) must be new and installed in the residence or business listed above prior to
submittal of this application. Resale units, units leased, rebuilt, rented, won as a prize or new parts
installed in existing units do not qualify.
3. For commercial lighting rebate applications, I understand IID reserves the right to require a pre-inspection
prior to approval of my application.
4. This signed and dated application, copies of receipts and invoices must be sent to IID Rebate Processing
Center postmarked by January 15, 2010, to be eligible for payment of a rebate. The rebate check for
qualifying item(s) will be mailed 6 to 8 weeks after receiving a completed application including all
required documentation and/or verification of installation.
5. I will allow, if requested, an IID representative reasonable access to my residence or business to verify
the installed item(s) I have purchased before a rebate is paid. I understand that a rebate will not be paid
if I refuse a verification inspection.
6. I agree that the selection, purchase, installation and ownership/maintenance of the product or improvement
listed in this application are my sole responsibility and that my supplier or installer of these products
or improvements is not an agent or representative of IID. I also understand that IID makes no warranty,
whether expressed or implied, including warranty of merchantability or fitness for any particular purpose,
use or application of the products or improvements. I agree that IID has no liability whatsoever concerning
(1) the quality, safety and/or installation of the products or improvements, including their fitness for any
purpose, (2) the estimated energy savings of the products or improvements, (3) the workmanship of any
third parties, (4) the installation or use of the products or improvements including, but not limited to,
effects on indoor pollutants, or (5) any other matter with respect to the Energy Rewards Rebate Program. I
agree that in no event shall IID’s liability for property loss or damage resulting from its activities under
this application exceed the total rebate amount paid to me under this application.
7. I am responsible for meeting all program requirements and complying with my state/county city
governments, property owner and/or homeowner’s association requirements (if any) in my area regarding
local conditions, restrictions, codes, ordinances, rules and regulations prior to installation.
8. I understand that the rebate amount per unit will be paid according to the rebate amounts per unit in
effect at the time the application is received by IID Public Programs.
9. If a tenant, I am responsible for obtaining the property owner’s permission to install the product or
improvement for which I am applying for a rebate. My signature on this application indicates I have
obtained this permission.
10. I understand that IID is not responsible for items lost or destroyed in the mail/transit.
11. I understand that only energy efficient products or improvements that are installed on electric equipment
are eligible for rebate and that the rebate amount can not exceed 50 percent of the purchase price and/or
installed cost. Non-electric efficiency measures, such as an ENERGY STAR® programmable thermostat
that only controls a gas furnace, are not eligible for an IID rebate.
12. I acknowledge that I have read and that I understand the appropriate residential or commercial program
requirements included in the Energy Rewards Rebate Program handbook. I understand that, in addition to
the terms and conditions in this form, I am bound by the terms and conditions contained in the handbook
for purposes of this rebate agreement.

I HAVE READ AND UNDERSTAND THE ABOVE TERMS AND CONDITIONS. I CERTIFY THAT THE INFORMATION I HAVE PROVIDED IS TRUE AND CORRECT AND
THE ITEM(S) AND/OR EQUIPMENT FOR WHICH I AM REQUESTING A REBATE MEETS THE REQUIREMENTS LISTED ON THE REBATE FORM.

X Customer Signature (required) Name (Please Print) Date

Funding is limited. Rebates are not guaranteed. Please call (760) 391-5951 for program information.
This program shall at all times be subject to change or termination without prior notice.
www.iid.com
 2009 For Residential and Commercial Customers
Energy Rewards Rebate Application
Only fully-completed applications will be processed.
NOTICE: To ensure prompt processing of this application, please refer to the separate Residential or Commercial
detailed instructions for the correct product or improvement to enter in the form below.

REBATE REBATE
PRODUCT OR IMPROVEMENT Model NUMBER QUANTITY
PER UNIT ($) TOTAL

REBATE GRAND TOTAL $

PAYMENT RELEASE FORM (To release your rebate payment to a third party payee, this form must be submitted with your rebate application form)

2009 Energy Rewards Program

I (Customer Name) ___________________ for IID Contract Account number ______________________ request that my 2009
Energy Rewards Program rebate check be made payable and sent to the third party below:
Third Party Designee:
Company Name: _________________________________ Mailing Address:________________________________
City/State/Zip: _________________________________ Payee Federal Tax ID Number: _ ____________
Payee Type (Check One): q Vendor q Parent Corporation q Landlord q Tenant q Other _______________
Payee Tax Status (Check one): q Corporation q Individual/Sole Proprietor q Partnership q Other __________
I understand that releasing payment to this third party does not exempt me from the program requirements outlined in the agreement on my 2009 Energy Rewards Program
rebate form. I also understand that I will not receive a rebate check from the Imperial Irrigation District. My potential 2009 Energy Rewards Program rebate amount has already
been figured into my vendor’s job estimate (if applicable). I also understand that my vendor may receive from IID and use certain information about my account, such as my
account number and rate information as required to resolve any issues pertaining to my 2009 Energy Rewards Program rebate.
Customer Signature:______________________________________ Customer Name:____________________________________
Company Name: _______________________________________ Title: _____________________________________________
Date: _______________________________________

Funding is limited. Rebates are not guaranteed. Please call (760) 391-5951 for program information.
This program shall at all times be subject to change or termination without prior notice.
www.iid.com