2016 Heating Conversion
$500 Early Bird Installation Agreement Incentive
INSTRUCTIONS:
Please retain this form UNTIL you have received your first natural gas bill.
To apply for your incentive, please fill out this incentive form completely, truthfully and accurately. Once you receive your first
natural gas bill, mail it with a copy of the completed Natural Gas Service Installation Agreement that was signed and dated within
the timeframe specified in the eligibility section below and with a copy of your first Southern Connecticut Gas (SCG) or Connecticut
Natural Gas (CNG) bill to:
EFI – CT Residential Natural Gas Conversion Incentive
40 Washington Street, Suite 2000
Westborough, MA 01581
ELIGIBILITY
This $500 incentive is valid for the prospects of the READY4WINTER16 project and who sign a Natural Gas Service
Installation Agreement between August 1, 2016 and October 31, 2016. Applicant’s property must be located on a
natural gas main, they must meet the terms and conditions of the Natural Gas Service Installation Agreement and
their first bill must show an active natural gas meter in place prior to December 15, 2016. Applicants must submit a
copy of their signed and dated Natural Gas Service Installation Agreement with this incentive form and a copy of their first
CNG or SCG gas bill and it must be postmarked on or before January 31, 2017. Only SCG or CNG new residential natural gas
heating conversion customers are eligible. This incentive may be subject to change without prior notice. SCG and CNG reserve
the right to conduct field inspections to verify conversion installations.
CUSTOMER INFORMATION
First Name (please print)
Last Name
Address
Home Phone
City / State / Zip
Cell Phone
Email Address
TERMS & CONDITIONS
APPLICATION: To apply for your incentive, this form must be filled out
completely, truthfully and accurately. The customer must submit this
completed incentive application along with a copy of the completed
Natural Gas Service Installation Agreement dated within the
timeframe specified in the eligibility section above and a copy of
their first CNG or SCG gas bill. Limit: One incentive per residential
natural gas account in the SCG or CNG service territory.
PAYMENT: Payment is processed after the customer has received
their first natural gas bill. Please allow up to 90 days for payment.
Payment may take longer if information is missing on the incentive
application. Please contact EFI at 877-560-6070 to inquire about the
status of your incentive application.
APPROVAL AND VERIFICATION: SCG and CNG reserve the right to
verify transaction and to have reasonable access to your residence to
inspect the equipment/system installed under this program prior to
issuing incentives, for up to one year after date of incentive
application.
TAX LIABILITY: SCG and CNG will not be responsible for any tax
liability that may be imposed on the customer as a result of the
payment of the incentive.
LIMITATION OF LIABILITY: SCG and CNG’s liability is limited to
paying the qualifying incentive specified. SCG and CNG are not
liable for any damages arising out of or resulting from
participation in this incentive offer, including but not limited to
loss of profits, loss of revenues, failure to realize expected
savings, loss of data, loss of business opportunity, or similar losses
of any kind, as well as any indirect, incidental, punitive, special, or
consequential damages, or for any damages in tort connected
with or resulting from participation in this program. Incentive
application cannot be reproduced, photocopied or altered in any
way.
For questions pertaining to natural gas service please call SCG or
CNG as applicable at 866-427-2888.
By signing this application form below, I certify that I am a new residential natural gas heating conversion customer of SCG or CNG. I
also certify that I reside at the address indicated above located within the SCG or CNG service area. I also understand that the $500
Early Bird Installation Agreement Incentive only pertains if the ELIGIBILITY and TERMS & CONDITIONS requirements of this Incentive
are met. Completion of this application is in no way a guarantee of receipt of this incentive. Customers are encouraged to make a
copy of this completed form for their records.
Customer Signature
Date
DO NOT RETURN this form to the Gas Company. See instructions above.
G0134 Rev. 08/16