SECTION C. EQUIPMENT & SERVICE INFORMATION (This section to be completed by contractor.) PLEASE PRINT
EQUIPMENT INFORMATION:
o
Furnace
o
Boiler
Manufacturer Serial Number
Model Name Model Number
BTU Rating Rated Efficiency (AFUE%)
SERVICE INFORMATION: Date of Service: ___________________________________ Cost of Service: ____________________________________________
FURNACE/BOILER CLEAN & TUNE-UP SERVICE CHECKLIST (please include separate sheets for multiple units):
TECHNICIAN: Please sign the front of this application to certify all checklist items have been completed!
o
Check filter; change as needed.
o
Complete visual inspection of system piping and insulation.
o
Check fan/pump motor; lubricate as needed.
o
Check adequacy of combustion air intake.
o
Clean burners, combustion chamber and heat exchange surface,
o
Adjust burner and gas input, manual, or motorized draft control.
o
Adjust air-flow and reduce excessive stack temperatures.
o
Check proper venting.
o
Clean and inspect burner nozzle.
o
Check safety controls.
o
Clean burners, combustion chamber and heat exchange surface,
when weather or operating schedule permits.
SECTION D. REBATE APPLICATION CHECKLIST
This program offers a $25 rebate for the completion of a professional clean and tune-up of your furnace or boiler. Use this checklist
to complete the steps to receive your rebates:
o 1. Read the following terms and conditions to determine if you are eligible for a rebate:
• Only one service address per application. Each service address is eligible every other year.
• The utility reserves the right to apply rebates to past due accounts.
• Furnace/Boiler Clean & Tune-Ups must be performed on equipment connected to a residential natural gas service supplied by Austin
Utilities or Owatonna Public Utilities and is subject to inspection.
• The Furnace/Boiler Clean & Tune-Up must be performed by a professional HVAC or boiler service technician. Austin Utilities and
Owatonna Public Utilities assume no liability for any incidental or consequential damages resulting from the Furnace/Boiler Clean &
Tune-Up provided by the service technician.
• The Furnace/Boiler Clean & Tune-Up must meet the Minimum Service Requirements as specified in this rebate application Section C.
EQUIPMENT & SERVICE INFORMATION.
• Due to limited funding, this rebate offer can be withdrawn at any time without notice. Applications will be processed on a first-come,
first-served basis. All applications from the previous year’s purchases must be received by March 31.
• Rebates can only be offered on Furnace/Boiler Clean & Tune-Up services that are completed while funding is in effect. In the event our
program is discontinued due to depleted funds, we will not provide a rebate for Clean & Tune-Up services completed between the
discontinued date and the end of that year.
• Austin Utilities and Owatonna Public Utilities assume no liability for any incidental or consequential damages resulting from the Clean
& Tune-Up service provided by the contractor.
o 2. Customer must complete Section A. Contractor must complete Sections B and C making sure to fill out all required sections in detail. Allow
6-8 weeks for processing. Missing or incorrect information will increase the processing time.
o 3.
Include a final, detailed copy of the original service receipt or invoice showing the customer name as well as the date and description of service.
o 4. Sign and date the application.
o 5. Information contained in this rebate application may be shared with the Minnesota Department of Commerce and our co-op partners.
o 6. Mail completed forms and required documentation to your utility provider:
Austin Utilities Owatonna Public Utilities
Attn: Rebate Processing Attn: Rebate Processing
1908 14th St NE PO Box 800
Austin, MN 55912-4904 Owatonna, MN 55060-0800
507-433-8886 507-451-2480
www.austinutilities.com www.owatonnautilities.com
or email: rebates@austinutilities.com or email: rebates@owatonnautilities.com
2
SECTION B. CONTRACTOR INFORMATION (This section to be completed by contractor.) PLEASE PRINT
ALL SERVICE WORK MUST BE PERFORMED BY A PROFESSIONAL HVAC OR BOILER SERVICE TECHNICIAN.
Business Name Technician Name
Mailing Address City State Zip Code
Daytime Phone Number (with area code) E-mail Address
PLEASE PRINT ON RECYCLED PAPER 0121
