Fuel conversion rebate application PSE fuel conversion rebate levels*

If you currently heat your home with electricity from Puget Type of heating Conversion rebate
Sound Energy, you may be eligible for up to a $3,950 rebate Home and water $1,950 - $3,950
to switch your home and water heating source to reliable Home only $500 - $2,500
and affordable natural gas.
Water only $950
For more information, contractor referrals or for help * Rebate amount is dependent on current type of home and/or water heating,
annual electricity usage and type of heating equipment installed. Rebate
completing this form, call a PSE Energy Advisor at
amount is limited to 75 percent of total equipment and installation cost.
1-800-562-1482, Monday through Friday, 8 a.m. to 5 p.m.
PSE equipment rebate levels**
Directions:
Carefully fill out this application and submit to PSE. Include a Type of equipment Equipment rebate
copy of your sales receipt or invoice. Please keep copies for
Furnace $250
your records.
Mail to: Puget Sound Energy, Fuel Conversion Rebate Storage water heater $50
Program, P.O. BOX 97034, EST-10W, Bellevue, WA 98009-9734 Tankless water heater $150-$200
Fax to: 425-456-2195 **Separate applications required for PSE equipment rebates. Visit
PSE.com/ForYourHome to download. Other natural gas providers may offer
different equipment rebates.

PSE ACCOUNT NUMBER (10 DIGITS)

Qualifications
• Conversion must be completed within an existing single-family
REFERRAL NUMBER (7 DIGITS)
residence of four units or less. Manufactured and mobile
homes are not eligible. Modular homes may qualify if on a
permanent foundation
NAME OF PERSON REBATE CHECK SHOULD BE MADE PAYABLE TO
• Applicant must be a PSE electric customer currently using
electricity as a primary source of home and/or water heating
DAYTIME PHONE • Rebate is subject to the current minimum annual electric usage
requirements, as determined by PSE
• Applicant must install ENERGY STAR qualified natural gas home
FULL INSTALLATION ADDRESS
and/or water heating equipment (fireplaces are not eligible)
• Applicant is ineligible for home heating rebate if a hybrid system
CITY STATE ZIP and/or heat pump is installed in conjunction with natural gas
equipment or if existing heat pump remains on the premises.
• Applicant is responsible for complying with all applicable codes
MAILING ADDRESS (IF DIFFERENT)
and regulations
• Rebate form must be submitted within 90 days of fuel and
CITY STATE ZIP equipment conversion
• Other requirements may apply
E-MAIL ADDRESS Yes, sign me up for PSE’s free Energy at Home e-newsletter.
PSE will review your rebate application and determine if your fuel conversion
project qualifies for the rebate. Rebate amount is paid directly to the customer.
Number of years in current home Rebate is limited to one per customer dwelling. Please allow six to eight weeks
to receive your rebate check. This is a tariffed service and is subject to change
Type of conversion: or termination without prior notice.
By signing below, I represent that I have read, understood and agreed to
Home and water heating Water heating only
the terms and conditions of this service and that all the information on this
Home heating only form is true. I agree to random inspections for program compliance by a PSE
Current type of heating: Baseboard Forced air representative. I authorize my new natural gas provider, if other than PSE, to
confirm my customer status and release a copy of my service agreement to PSE
Yes, I have also filled out PSE rebate applications for natural gas for the purposes of confirming my eligibility to receive this rebate.
heating and/or watering heating equipment.
Further, I acknowledge that my existing primary heating system, either home
What other types of natural gas appliances do you plan and/or water, was electric and was replaced with a natural gas system at
on purchasing? the location indicated. I know that PSE has made no implied or expressed
warranties or representation with regard to this conversion or energy savings
Range Barbecue Fireplace from its completion.
Clothes dryer Other_____________________________
(Please explain) SIGNATURE _______________________________________________

3405 12/09 DATE _______/_______/_______