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First Name Last Name
Initial
Installation Address City State Zip Code
Day Time Phone
Customer Account Number
Purchase Date(s)
Installation Date(s)
Attic Insulation
Circle items that apply:
Windows Sliding / French Doors Whole House Fan
(For doors & windows see worksheet on page 2)
Attic Insulation:
Rating/Level __________ (i.e. R-19) Total sq. ft installed _____________
Exterior Wall Insulation:
Rating/Level __________ Total sq. ft installed _____________
Whole House Fan
Mfg #_________________
Mfg#_____________
Mfg#_____________
Model#______________________ Qty________________
I certify that I am the owner(s) or tenant(s) of the real property where the improvements have been installed and that I
have not previously received, or applied for, other utility financing or incentives for the improvements on this application.
I also certify that the foregoing information is true and correct. I understand and agree that the choice of improvements,
the selection of contractors, the purchase of items and acceptance of materials used and work performed, and the
payments thereof, is my responsibility. I understand that the City of Banning does not endorse, recommend or make any
representations as to specific brands, products, contractors or dealers; nor does it guarantee material or workmanship. I
also agree to allow the City of Banning Public Utilities to access my premises for verification purposes.
City of Banning
Residential Energy Conservation/
Weatherization Rebate Application
_________________________________________
Applicant Signature
_________________________________________
Property Owner Signature
Date:________________
Date:________________
*If Renter, property owner must sign here to release rebate amount to applicant. For office use only:
_____________________________
Date
_____________________________
Authorization for payment:___________________
Signature_____________________________________
(Public Benefits Coordinator
Signature_____________________________________
(Public Benefits Program Manager)
Date
Audit Completed ______________________Date___________________Cycle____________
City of Banning, Public Benefits, 176 E. Lincoln St., Banning, CA 92220 (951) 922-3260 Banningca.gov
Email: PublicBenefits@banningca.gov
Exterior Wall Insulation
Email Address
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signature
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signature
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