Sunteți pe pagina 1din 2

Gulf Power EarthCents Rewards

Residential Incentive Application Energy Select Electric Vehicle Charging Program

Application Energy Select Electric Vehicle Charging Program You must be enrolled in Energy Select to participate

You must be enrolled in EnergySelect to participate in this program. To ensure eligibility for program please visit www.gulfpower.com/earthcents

Completely fill out each section; incomplete forms will not be processed. Include the following:

1. completed application form

2. a copy of your itemized sales receipt of vehicle, including labor if applicable, marked paid

3. a copy of manufacturer’s documentation showing type of vehicle and charging options level

Mail to: Gulf Power EarthCents Rewards, One Energy Place, Pensacola, FL 32520-0950. Or email to: earthcentsrewards@gulfpower.com

Make a copy of this application for your records. For more information, call 1-877-655-4001.

Gulf Power Account Number:

call 1-877-655-4001 . Gulf Power Account Number: Name (on account): Email: Service Address: City:

Name (on account):

Email:

Service Address:

City:

State:

Zip:

Daytime Phone:

Incentive paid to: Name

Email:

Mailing Address:

City:

State:

Zip:

PHEV, EREV, BEV ($1,000 per customer) LSV ($500 per customer)

PHEV, EREV, BEV ($1,000 per customer)

PHEV, EREV, BEV ($1,000 per customer) LSV ($500 per customer)

LSV ($500 per customer)

Product purchased (i.e. PHEV, EREV, BEV/LSV:

Purchased from:

Date Purchased:

VIN #:

Manufacturer:

Model:

Year:

Charge Controlled by:

Model: Year: Charge Controlled by: Energy Select (not to exceed 30 amps) On-board

Energy Select (not to exceed 30 amps)

Model: Year: Charge Controlled by: Energy Select (not to exceed 30 amps) On-board

On-board

Terms and Conditions: Must be a Gulf Power residential customer enrolled in EnergySelect. Must submit application within 60 days of purchase date. Product must be purchased on or after June 1, 2011, during the effective dates of the program. Must not be leased. Incentive amount not to exceed total project cost. Allow 6-8 weeks for incentive.

How did you hear about this program?

weeks for incentive. How did you hear about this program? Salesperson Newspaper Gulf Power bill insert

Salesperson

incentive. How did you hear about this program? Salesperson Newspaper Gulf Power bill insert Radio/TV Referral

Newspaper

How did you hear about this program? Salesperson Newspaper Gulf Power bill insert Radio/TV Referral Gulf

Gulf Power bill insert

Radio/TVthis program? Salesperson Newspaper Gulf Power bill insert Referral Gulf Power website Other I hereby certify

ReferralSalesperson Newspaper Gulf Power bill insert Radio/TV Gulf Power website Other I hereby certify that I

Newspaper Gulf Power bill insert Radio/TV Referral Gulf Power website Other I hereby certify that I

Gulf Power website

Other

I hereby certify that I am a Gulf Power residential customer, all information on this form is accurate and I have read and accept the Program Requirements listed at www.gulfpower.com/earthcents; I acknowledge that Gulf Power will make the final determination of any incentive that I will receive and may verify the information provided, including verification of the product(s) installed at the service address. Program is subject to change or cancellation without notice.

Customer Signature

Date

or cancellation without notice. Customer Signature Date I wish to donate my entire incentive for products

I wish to donate my entire incentive for products listed above on this form to Project Share, an energy assistance program in which Gulf Power partners with the Salvation Army to help those in need.

Project Share, an energy assistance program in which Gulf Power partners with the Salvation Army to

Residential Energy Select Electric Vehicle Charging Program

The objective of this program is to encourage residential customers to charge electric vehicles during overnight, off-peak time period by participation in Energy Select ® program. Off-peak charging will help Gulf Power efficiently manage an increasing demand for electricity from electric transportation customers.

Eligibility: This program is available to all Gulf Power residential customers who are eligible for and agree to remain on the Residential Service Variable Pricing (RSVP) rate as part of the Energy Select ® Program for one year.

Customers must agree to use an Energy Select ® Load Control Relay to control the vehicle charging circuit (240v or less and 30 amps or less) or show proof of an in-vehicle controller capable of charging the vehicle only during RSVP off-peak hours.

Eligible vehicles include highway capable all-Electric, Plug-in Hybrid Electric (PHEV), and Extended Range Electric (EREV) vehicles. Examples of eligible vehicles include the following: Ford’s plug-in hybrid Escape, Ford’s all-electric Focus, Chevrolet’s extended range electric Volt, Nissan’s all-electric Leaf, Toyota’s plug-in hybrid Prius, and Volkswagen’s all-electric Golf.

Low-Speed 1 electric vehicles designed for on-road use, also known as Neighborhood Electric Vehicles or NEVs, purchased by an eligible customer during the pilot also are eligible.

This program is limited to 100 participants per calendar year.

Itemized Paid Sales Receipt as Proof of Purchase: Participating customers must submit to Gulf Power a completed incentive application form no more than 60 days after purchase. This application must be submitted with an itemized list of the new qualifying product/equipment purchased. The list must indicate date of purchase, and qualifying information about the product/equipment such as the make model, and manufacturer’s specifications.

Incentive: This incentive will be paid in the form of a check for the following:

a. $1,000 for highway-capable vehicle

b. $500 for low-speed vehicle