Residential Electric and/or Natural Gas Equipment Rebate
Mail to:
Central Hudson Rebate Center • 980 Beaver Creek Drive • Martinsville, VA 24112
(Please do not send this form with your utility bill payment.)
CUSTOMER INFORMATION
Name Central Hudson Account Number
Installed Address City State ZIP Code
Email Address Home Phone Work Phone
Trade Ally Company Name* Trade Ally Phone Number Date of Installation
What type of residence do you live in?
Single Family
2- to 4-Unit Apartment
5+ Unit Apartment
Duplex
Mobile
Townhouse/Rowhouse
What is your home‘s existing heating system type?
Furnace
Hydronic Boiler
Steam Boiler
Heat Pump
Electric Baseboard
Space Heater
Fireplace/Stove
Does your home have natural gas?
Yes
No
Does your home have central air conditioning?
Yes
No
How did you hear about this program?
Bill Insert
Postcard or Other Mailing
Website
Email
Radio
Newspaper
Trade Ally
Other:
General Terms and Conditions for Residential Customers
1. Equipment and services must be purchased Jan. 1, 2021 through Dec. 31, 2021.
2. Work must be completed by a participating Central Hudson Trade Ally.
3. Incentives are available for residential gas and electric customers of Central Hudson.
4. It is the responsibility of the customer to ensure that all requirements for the rebate are met and
that all required documentation is provided.
5. Rebate payments will be based on the equipment purchase date.
6. Failure to provide any of the required information will prevent processing of the application.
7. Central Hudson reserves the right to review the installations in order to ensure compliance with all
program requirements. Central Hudson may choose to review locations to verify completion of the
projects and to measure and verify energy savings. Such reviews will be made at a time convenient
to the applicant, with advanced notice given to the applicant. Misrepresentation of installation
location or measure eligibility may result in forfeiture of the incentive award.
8. Program procedures, requirements and rebate levels are subject to change or cancellation
without notice.
9. One rebate check will be issued to the customer for each approved and completed application.
Where applicable, a separate check will be issued to the contractor for each approved and
completed application.
10. Installations must be completed in accordance with all laws, codes and other requirements
applicable under federal, state and local authority.
11. The customer is urged to seek appropriate consultation concerning any tax liabilities that could
be associated with the receipt of the rebate.
12. The customer veries that they have not received any other incentives from any other state
programs for the same equipment for which a rebate is being requested in this form.
13. Central Hudson is entitled to 100% of the energy benets associated with the rebated measures,
excluding the value of energy cost savings realized by the customer.
14. Central Hudson assumes no responsibility for the performance of the equipment and equipment
warranty, the quality of the work, labor and/or materials supplied, and/or the acts or omissions of
the Trade Ally.
15. The equipment must be purchased new and installed at the above listed customer location.
16. The customer hereby relieves and indemnies Central Hudson of any and all liability associated
with this project.
17. The customer understands that he or she may be contacted by Central Hudson via survey or
questionnaire to provide feedback on his or her satisfaction with the program.
By signing this application, the customer agrees to the terms and conditions of this document. The customer hereby consents to the utilization and release of his or her energy consumption data and usage by Central Hudson
and/or its designees, including program administrators and evaluation contractors. These administrators and contractors are obligated to Central Hudson to keep customer information condential. The release and usage of data
will be only for program evaluation, program eligibility determination, energy savings purposes and analysis and will be kept condential.
Customer Signature Date
*Self-installs allowed for heat pump water heaters and smart thermostats only.
CHNY-RER0910-R3
Central Hudson Gas & Electric provides rebates to residential customers for installing high eciency HVAC equipment that meets
program requirements. Except for heat pump water heaters, all equipment must be installed by a participating Central Hudson
Trade Ally, all of whom are listed on SavingsCentral.com/TradeAllies. To receive your rebate, please ll out this form completely and
mail it to the address below with:
A copy of your dated sales receipt from a Central Hudson Trade Ally
An AHRI Certication or Manufacturer‘s specication sheet, including model numbers
and performance ratings (provided by your Trade Ally)
Central Hudson Gas & Electric has evaluated and qualied energy saving measures listed on this page. For an energy eciency measure to be eligible, it must
meet the minimum program requirements. If you have questions or need assistance, please call 800-515-5353 or visit CentralHudson.com/Incentives.
Please ensure that the product meets the standards in the table below. Trade Ally should complete the other side of this application.
Please expect 5-7 weeks for rebate amount delivery after your submission.
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