I hereby request a rebate for the listed work.

Attached are copies of

À MAKE
SURE YOU
R

Massachusetts
all receipts. I have read and agree to the Terms and Conditions APPLICATION CHECKLIST APPLICAT
ION IS
below. I certify that a licensed contractor has installed the listed COMPLET
Attach copies of all receipts with equipment make, model and size E!
high-efficiency natural gas heating and/or water heating system in
documenting the installation of the equipment.
accordance with Program Guidelines and Terms and Conditions as

2010 Rebates
described on this form. Complete all questions, read all terms and conditions, and sign the application.
Make sure utility and account number are listed above.
Make a copy of the front and back of this application for your records.
SIGNATURE
Mail completed, signed application and all corresponding documentation to:
GasNetworks, 112 Elm Street, Pittsfield, MA 01201
High-Efficiency Heating & Hot Water Equipment
DATE
Please allow 4-6 weeks for your rebate request to be processed.
Some restrictions may apply. Rebate offers are subject to change without notice.

TERMS AND CONDITIONS Rebates for Home and Small Business

1. Customer Eligibility
You must be a Massachusetts residential or commercial heating customer of Bay State Gas, Berkshire Gas, Blackstone Gas,
National Grid (MA), New England Gas, NSTAR Gas, or Unitil to qualify. Equipment purchases and installations made between
February 1, 2010 and December 31, 2010 are eligible for rebate. Equipment must be installed by a licensed heating or plumbing
contractor at the customer’s address listed on the GasNetworks Rebate Form. Rebate form must be filled out completely,
signed and accompanied by dated receipts, and received by GasNetworks within 60 days from installation date. Rebate form
must be received by GasNetworks by January 31, 2011.
2. Installation Verification
Prior to honoring any rebate, GasNetworks reserves the right to conduct an on-site verification that the equipment has been
installed according to Program Guidelines and is in operation. This site visit, and all aspects related to this site visit, are
conducted solely for such purpose. The site visit is not a safety review, nor is it intended for any other purpose.
3. Warranties
GasNetworks and the Rebate Administrator do not endorse, guarantee or warrant any particular contractor, manufacturer
or installation.
4. Changes to High-Efficiency Equipment Rebate Program
Program is subject to change without prior notice, and rebate offers may increase or decrease at any time.
5. Tax Liability
Participants of the program may be subject to tax liability for the value of goods and services received through the program
pursuant to state or federal income tax codes.
6. No Tax Liability to GasNetworks and Rebate Administrator
GasNetworks and the Rebate Administrator are not responsible for any tax liability which may be imposed as a result of receipt
of the rebates provided by the natural gas utility to the customer.
7. Liability & Release
As part of the consideration for participating in the program, participant hereby releases and shall indemnify, hold harmless and
defend GasNetworks, its member utilities, and the Rebate Administrator from any and all claims, losses, harm, costs, liabilities,
damages and expenses (including attorneys’ fees) of any nature whatsoever arising directly or indirectly out of or in connection
with the installation of high-efficiency equipment at the premises or any material and labor required for such installation.
8. Changes to Rebate Amounts
GasNetworks will provide rebates for approved equipment up to the rebate amount indicated in this application. Projects greater
than ten (10) require pre-approval from GasNetworks for rebate funds to be reserved.

F R E Q U E N T LY A S K E D Q U E S T I O N S

1. What is GasNetworks? GasNetworks is a collaborative consisting of local gas companies whose mission is to work with
governmental agencies and affiliates to promote energy-efficient technologies, create common efficiency programs, educate iency
consumers, and promote contractor training and awareness of ever-changing natural gas technologies. High-effic o may
nt als
2. What is the purpose of the GasNetworks Rebate Program? The purpose of the program is to encourage customers to equipme l Tax Cred
its.
purchase and install energy-efficient equipment. Your gas company provides a rebate to cover a portion of the additional cost r Fed era
for purchasing the energy-efficient equipment versus standard efficiency equipment. qualify fo .energystar.gov/
w
3. How can I recognize this equipment? A customer or contractor who is uncertain about whether equipment meets the Visit ww its for more
efficiency criteria should check with a local distributor or manufacturer. For questions regarding eligible equipment, please taxcred tion.
call the GasNetworks Rebate Administrator at 1-800-944-3212 or contact your heating or plumbing contractor.
informa
4. Where can I find a contractor to install the equipment? Refer to the ENERGY STAR® website at www.energystar.gov
for tips on how to find the right contractor, and check the local Yellow Pages for a complete list of licensed plumbers or
heating contractors that specialize in gas heating and water heating systems.
5. When will I receive my rebate? Pending approval, we will process and mail the rebate within 4 to 6 weeks of receipt of the
properly completed and signed application. Bay State Gas • Berkshire Gas • Blackstone Gas •
National Grid (MA) • New England Gas •
For questions regarding this program, please call 1-800-944-3212 or email [email protected]. NSTAR Gas • Unitil
For more forms and information on other rebate programs, visit www.gasnetworks.com.
BG 02/10 ©2010 GasNetworks. All Rights Reserved.
 ELIGIBLE EQUIPMENT REBATE GasNetworks Rebate Form
Be sure to attach copies of all your receipts and mail them with this signed application to:
High-Efficiency Equipment HIGH-EFFICIENCY NATURAL GAS GasNetworks, 112 Elm Street, Pittsfield, MA 01201
WARM AIR FURNACE
Rebate Program PLEASE CHECK YOUR GAS UTILITY:
NATIONAL GRID (MA)
BAY STATE GAS
NEW ENGLAND GAS
BERKSHIRE GAS
NSTAR GAS UNITIL
BLACKSTONE GAS

AFUE* Rating 94% or greater w/Electronic Commutated Motor $650

or listed on www.gasnetworks.com as electrically efficient
GAS UTILITY ACCOUNT NUMBER:
H O W T O PA RT I C I PAT E : AFUE Rating 92% or greater w/Electronic Commutated Motor $500 (where equipment was installed) (utility account numbers may vary—all boxes may not be necessary)
or listed on www.gasnetworks.com as electrically efficient
( ) ( )

1 Consult your licensed heating contractor or plumber

for a listing of models that are eligible for the
GasNetworks Rebate Program.
These rebates are in partnership with National Grid, NSTAR Electric,
Western Massachusetts Electric Company, and Cape Light Compact.
NAME

INSTALLED ADDRESS
HOME PHONE

CITY
WORK PHONE

STATE ZIP
AFUE Rating 92% or greater $400

2 Once your new natural gas, high-efficiency heating

system and/or high-efficiency water heating system
has been installed, review and complete this rebate
HIGH-EFFICIENCY NATURAL GAS BOILER
MAILING ADDRESS (if different)

HIGH-EFFICIENCY NATURAL GAS FURNACE REBATE

CITY STATE ZIP

Hot Water Boiler – AFUE Rating 90% or greater $1,000

application. Then attach a copy of all dated receipts/work WHAT DID YOU INSTALL? NATURAL GAS FURNACE ≥ 92% AFUE NATURAL GAS FURNACE W/ECM ≥ 94% AFUE

Hot Water Boiler – AFUE Rating 85% or greater $500 NATURAL GAS FURNACE W/ECM ≥ 92% AFUE
orders that document the installation. Make sure that these
receipts indicate the name, license #, address, and phone
Steam Boiler – AFUE Rating 82% or greater $200 MANUFACTURER MODEL #
number of the contractor that completed the installation.

3 Mail the signed rebate form with attached

receipts to:
GasNetworks
COMBINED HIGH-EFFICIENCY BOILER
AND WATER HEATING UNIT

On-Demand Condensing Unit—Minimum AFUE Rating of 90% $1,600

AFUE DATE INSTALLED

REBATE AMOUNT $____________

TOTAL COST

REPLACED UNIT INFORMATION: GAS

INSTALLED BY (CONTRACTOR NAME)

OIL ELECTRIC PROPANE NEW CONSTRUCTION

112 Elm Street with hot water storage of 2 gallons or less HIGH-EFFICIENCY NATURAL GAS BOILER AND COMBINED BOILER/WATER HEATING UNIT REBATES
Pittsfield, MA 01201 WHAT DID YOU INSTALL? NATURAL GAS STEAM BOILER ≥ 82% AFUE NATURAL GAS HOT WATER BOILER ≥ 85% AFUE
On-Demand Non-Condensing Unit—Minimum AFUE Rating of $1,000
85% with hot water storage of 2 gallons or less NATURAL GAS HOT WATER BOILER ≥ 90% AFUE NATURAL GAS ON-DEMAND CONDENSING UNIT ≥ 90% AFUE
Make sure to make a copy of the rebate form for your records.
NATURAL GAS ON-DEMAND NON-CONDENSING UNIT ≥ 85% AFUE
HIGH-EFFICIENCY INDIRECT WATER HEATER
PROGRAM GUIDELINES: MANUFACTURER MODEL #
Attached to a natural gas boiler (minimum 20-gallon tank size) $500
• You must be a Massachusetts customer of a AFUE DATE INSTALLED TOTAL COST INSTALLED BY (CONTRACTOR NAME)
CONDENSING GAS WATER HEATER
GasNetworks member utility: Bay State Gas, Berkshire
REBATE AMOUNT $____________ REPLACED UNIT INFORMATION: GAS OIL ELECTRIC PROPANE NEW CONSTRUCTION
Gas, Blackstone Gas, National Grid (MA), New England 95% thermal efficiency or greater (75 to 300 MBH) $500
Gas, NSTAR Gas, or Unitil. HIGH-EFFICIENCY NATURAL GAS WATER HEATER REBATE
HIGH-EFFICIENCY ON-DEMAND, TANKLESS
• All installations of high-efficiency heating systems WHAT DID YOU INSTALL? INDIRECT WATER HEATER ON-DEMAND TANKLESS WATER HEATER ≥ .82 ENERGY FACTOR W/ELECTRONIC IGNITION
WATER HEATER
ENERGY STAR®-RATED STORAGE WATER HEATER WITH .62 ENERGY FACTOR CONDENSING GAS WATER HEATER
(furnaces and boilers) and/or water heating systems
(indirect, storage, or on-demand tankless) must be .82 EF (Energy Factor) or greater with Electronic Ignition $700
MANUFACTURER MODEL #
installed by a licensed contractor and/or plumber. All
ENERGY STAR®-RATED STORAGE WATER HEATER
installations must conform to all applicable codes and DATE INSTALLED TOTAL COST INSTALLED BY (CONTRACTOR NAME)
be installed in accordance with all rebate Program .62 EF (Energy Factor) $50
Guidelines. REBATE AMOUNT $_____________ REPLACED UNIT INFORMATION: GAS OIL ELECTRIC PROPANE NEW CONSTRUCTION
AFTER-MARKET BOILER RESET CONTROLS
• All proof of purchase receipts, work orders or other AFTER-MARKET BOILER RESET CONTROLS
documentation must include the contractor name/ Must be connected to a natural gas boiler $200
license #/address/phone number, installation cost, MANUFACTURER MODEL #
and an itemized description of the equipment, including ENERGY STAR®-LABELED OR 7-DAY
PROGRAMMABLE THERMOSTAT
manufacturer, model number, and AFUE (Annual Fuel QUANTITY _____ TOTAL COST $____________ REBATE AMOUNT $____________

Utilization Efficiency) or EF (Energy Factor) rating, (rebate not to exceed the purchase price) Please include a dated receipt and original UPC code from the package.
There is a two-rebate limit per account, and the rebate $25
as applicable. cannot exceed the purchase price of the thermostat.
ENERGY STAR®-LABELED OR 7-DAY PROGRAMMABLE THERMOSTAT REBATE
• All installations are subject to verification that the $25 REBATE FOR ENERGY STAR®-LABELED OR 7-DAY PROGRAMMABLE THERMOSTAT (LIMIT 2 PER ACCOUNT)
*Annual Fuel Utilization Efficiency
equipment has been installed and is operational.
MANUFACTURER MODEL #
• Please read all Terms and Conditions on the reverse
of the rebate application. ADDITIONAL REBATE OFFERS QUANTITY _____ TOTAL COST $____________ REBATE AMOUNT $____________

• Rebate offers subject to change without notice. For more information about the wide array of GasNetworks (rebate not to exceed the purchase price) Please include a dated receipt and original UPC code from the package.

Some restrictions may apply. Energy Savings Rebates and Programs, log on to
www.gasnetworks.com or call 1-800-944-3212 Please sign and date this rebate form on reverse side.