ELECTRIC WATER HEATER CONTRACT*
NOTE: Please submit this form, along with invoice, only after the electric water heater has been installed. Rebates will be paid according to the
options listed below for a residential single family dwelling or commercial facility served by Georgia Power where applicable.
Qualifying systems for conversion rebates include electric steel-tank, electric tankless, Marathon®, and heat pump water heater
FORM MUST BE SUBMITTED BY DECEMBER 31, 2016 TO QUALIFY FOR REBATES LISTED BELOW
□ Electric Steel-tank (40 gal minimum) or Electric Tankless (18kW minimum) Water Heater CONVERSION ($400 Rebate)
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Residential single family - To achieve savings and qualify for the rebate must cancel natural gas service
$400 CONVERSION REBATE ALLOCATION (check only one of the following boxes):
Contractor and Customer/Owner ($100 / $300)
Contractor and Salesperson** ($200 / $200)
Salesperson and Customer/Owner ($100 / $300)
Salesperson Only** ($400)
Contractor Only** ($400)
Customer/Owner Only ($400)
**When not paying the customer, the Customer/Owner Rebate Waiver must be signed below.
□ Marathon® Water Heater CONVERSION (40 gal min.) ($525 Rebate Paid to Customer ONLY) (Residential or Commercial facility)
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Residential single family or Commercial facility replacing fossil fuel (e.g. gas or propane) water heater – cancelling natural gas service not required

Residential single family replacing fossil fuel (e.g. gas or propane) water heater – cancelling natural gas service not required

Residential single family replacing Steel-tank Electric Water Heater
□ Heat Pump Water Heater CONVERSION (EF > 2.0) (Electric Steel Tank Rebates Apply Plus Additional $250 Rebate Paid to Customer ONLY)
□ Heat Pump Water Heater REPLACEMENT (EF > 2.0) ($250 Rebate Paid to Customer ONLY)
CONTRACTOR INFORMATION
Contractor Name:
Contractor Phone:
Salesperson:
Contractor Number:
Salesperson Number:
CUSTOMER INFORMATION
 Check if this a Rental House (if rental, must complete Installation Address and Property Owner Information)
Installation Address (Required- Where the water heater was installed)
Property Owner Information (if different than installation address)
Name:
Name:
Address:
Address:
City,
State,
Zip:
City,
State,
Zip:
Phone Number:
Phone Number:
HOUSE AND EQUIPMENT INFORMATION
Date Installed
Unit
House Square Footage (Residential Only)
Water Heater
Make/Brand
Water Heater Model #
Capacity (gallons)
Or
kW (electric tankless)
Number of Units Installed
EF
Whole House
Space Heating Type
(Gas or Electric)
Previous Water
Heating Type
(Gas or Electric)
1
2
**CUSTOMER/OWNER REBATE WAIVER
I understand that I waive my rights to any rebate or other program benefits, provided by Georgia Power, regarding this property.
Signature
Date
(Customer/Owner)
Terms and Conditions: All installations and rebates under this program are subject to visual verification by the Georgia Power Corporate Compliance Organization. If the field audit
discovers the equipment has not been installed, or any other non conforming condition exists, dealer will be subject to GPC probation policy and dealer/customer may be billed for
repayment of any rebates to Georgia Power. By submitting this contract, applicant acknowledges and agrees that Georgia Power’s liability and responsibility in connection with any rebate
program shall be strictly limited to the making of certain rebate payments to eligible applicants, and that Georgia Power is not making, will not be providing and specifically disclaims
any representations, warranties, covenants or guaranties whatsoever, expressed or implied, in connection with the equipment or the program itself, including, without limitation, those
regarding merchantability or fitness. Warranties with respect to the equipment are strictly manufacturer’s warranties, and applicant shall not make, nor have the right to make, any claims
against Georgia Power relating to any such warranty. Georgia Power shall in no way be liable or responsible for any equipment installed or any act or omission of any other entity or
individual, including, without limitation, any dealer, technician or other service provider. Georgia Power reserves the right to cancel or modify the rebate program at any time in its sole
discretion.
Electric steel-tank water heater conversions only: By checking this box I have verified the natural gas service has been canceled
I certify the above information is correct and agree to the Terms and Conditions of this contract.
Signature
Date
(Contractor or Customer/Owner)
GPC Rep Name:
Fax Number:
Phone Number:
* A licensed contractor may use this form to report electric water heater conversions, in the existing market, on Georgia Power lines.
For further information call your local Georgia Power Company Sales Representative or 1-800-524-2421.
EWHSFE010116
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