REBATE APPLICATION FOR PROJECTS COMPLETED BY 12/31/2026
Complete all sections. Incomplete applications cannot be processed and will delay payment of rebates. Applications must be submitted within 60 days of completed project installation , no later than January 31, 2027. For additional copies of this form, visit focusonenergy.com/catalogs . section 1 ACCOUNT AND CUSTOMER INFORMATION Tax Identification Number (Check one) q FEIN or q SSN* *If you use a Social Security Number (SSN) as your Tax Identification
section 4 TRADE ALLY INFORMATION _________________________________________________________ TRADE ALLY CONTACT NAME _________________________________________________________ PRIMARY PHONE # EMAIL ADDRESS _________________________________________________________ TRADE ALLY COMPANY NAME _________________________________________________________ ADDRESS _________________________________________________________ CITY STATE ZIP
Number, do not provide it below . You will be contacted by the Program via email to provide a copy of your W-9 using a secure online portal, if it is not already on file. You must list an email address in Section 3. _________________________________________________________ FEIN TAX CLASSIFICATION OF CUSTOMER (Check one. Required for all businesses, including non-profits.) q Sole Proprietorship q S Corporation q Partnership q C Corporation q LLC - S Corp q LLC - Partnership q LLC - C Corp q Single-Member LLC q Other ____________________________ _________________________________________________________ OWNER NAME (REQUIRED IF SSN IS USED AS TAX IDENTIFICATION NUMBER) _________________________________________________________ COMPANY NAME _________________________________________________________ LEGAL ADDRESS (AS SHOWN ON COMPANY W-9) _________________________________________________________ CITY STATE ZIP _________________________________________________________ WHO DID YOU WORK WITH FROM FOCUS ON ENERGY? (CONTACT NAME) section 2 JOB SITE INFORMATION (Refer to your utility bills for account numbers below.) _________________________________________________________ JOB SITE BUSINESS NAME _________________________________________________________ ELECTRIC UTILITY AT JOB SITE ELECTRIC ACCOUNT # _________________________________________________________ GAS UTILITY AT JOB SITE GAS ACCOUNT # q JOB SITE ADDRESS IS SAME AS LEGAL ADDRESS q JOB SITE ADDRESS IS DIFFERENT (COMPLETE BELOW) _________________________________________________________ JOB SITE ADDRESS _________________________________________________________ CITY STATE ZIP section 3 CUSTOMER CONTACT INFORMATION _________________________________________________________ JOB SITE CUSTOMER CONTACT NAME _________________________________________________________ PRIMARY PHONE # EMAIL ADDRESS Preferred method of contact: q Call q Email q Text If Focus on Energy has a question about this application, we should contact: q Customer q Trade Ally q Other_________________
section 5 BUSINESS PAYMENT INFORMATION Payee is responsible for any associated tax consequences. Make rebate check payable to:
q Customer q Trade Ally q Other Payee q Rebate Administrator If Other Payee is selected, the relationship to the utility account holder must be identified below: q Tenant q Building Owner q Other (specify) _________________ For All Payees this Section MUST be Filled Out Mail check to: q Customer Legal Address q Job Site Address q Trade Ally Address q Alternate Address _________________________________________________________ COMPANY NAME _________________________________________________________ ADDRESS _________________________________________________________ CITY STATE ZIP _________________________________________________________ ATTENTION TO (OPTIONAL) For Trade Ally, Rebate Administrator, and Other Payees Trade Allies must be registered with the Program to receive payment. All other payees must have a current W-9 on file to receive payment. Tax Identification Number (Check one) q FEIN or q SSN* *If you use a Social Security Number (SSN) as your Tax Identification Number, do not provide it below. You will be contacted by the Program via email to provide a copy of your W-9 using a secure online portal, if it is not already on file. You must list an email address below. _________________________________________________________ FEIN Tax Classification of Payee (Check one. Required for all businesses, including nonprofits.) q Sole Proprietorship q S Corporation q Partnership q C Corporation q LLC - S Corp q LLC - Partnership q LLC - C Corp q Single-Member LLC q Other _____________________________ Payee Contact Information _________________________________________________________ NAME EMAIL ADDRESS
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