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2. 
3. Please complete

   All information is required to process rebates.  

5. Name
6. Email Address
8. Address
10. City
11. State
12. Zip Code
14. Phone Number
15. Utility Account Number*
17. Mailing Address (if different)
19. City
20. State
21. Zip Code
23. Electic Heat Source*
    -- Select One --Wall UnitHeat PumpBaseboardForced-Air ElectricOther
24. Residence Type*
    -- Select One --Single FamilyManufactured Home
26. Existing Windows & Frames*
    -- Select One --Single PaneDouble Pane
27. Existing Patio Doors, Windows & Frames*
    -- Select One --MetalWoodVinyl
29. Tp qualify:

    Single family and manufactured residences must have a permanently installed, electric heat system capable of heating the entire dwelling.  Window rebate(s) are for replacement only and do not cover the enlargment of existing windows.  

31. Window Rebates
33. U-Value and Rebate*
    -- Select One --.22 or lower (<.31 for patio doors) = $10 per sq ft.23-.30 (.31-.35 for patio doors) = $8 per sq ft

35. Rebates will not exceed the installed job cost. Rebates for self-installed measures will not exceed 100% of the cost of materials.  

37. Measure Informatoin*

    Sq feet of new windows

38. U-Value*

    U-Value

40. ALL REQUESTS FOR REBATE FUNDS MUST BE PRE-APPROVED

    If work is not completed within three(3) months of approval, customer must reapply for rebate(s).  There is no guarantee that funds will be available after the three-month approval of that the incentive amount will remain the same.  

42. REQUIRED DOCUMENTATION

    use this checkleist fot help compile your documents for submission

44. Low-E Storm Windows

    1. A copy of the ENERGY STAR product list showing the product or the products information insert
    2. Any packaging that includes the ENERGY STAR logo
    3. Documentation of number and square footage of storm windows installed
45. Windows and Patio Doors

    1. NRFC stickers or other verfication of U-value
    2. Documentation of (a) number and sq footage of windows replaced; and (b) post condition U-value
47. Upload Reciept of Purchase/Install*
49. Upon signing this agreement, customer ackonwledges the following:

    Rebate offer(s) may be changed or discontinued at any time by FGL&P.  FGL&P disclaims any warranty, whether expressed or implied, regarding the measure(s) listed on this application for any materials or labor associated with installation, maintenance, repair, or any energy savings associated with use.  

    I understand that the measure(s) must be installed to FGL&P specifications and certify that I, or my contractor have reviewed the specifications prior to beginning work.  When selecting a contractor, I understand that it is the homeowner's responsibility to request proof of insurance and licensing that meets the statutes and rules of the Oregon Construction Contrators Board.  FGL&P strongly encourages validating qualifications before work begins.  

51. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
53. Electronic Signature*
54. Date*
    Date
56. Processing

    Rebate(s) will be paind with FGL&P has received a complete rebate application and all required documentation for the project.  Documentation must include copies of contractor's final invoice(s) and a copy of one NFRC sticker per window. Contractor's final invoice(s) must include window measurements.  

57. Upload Invoice(s), Receipt(s), or Project Documentation*
Leave This Blank:


61. 1. Receive an email copy of this form.
62. Email address

    This field is not part of the form submission.

63. Submit Submit and Print

* indicates a required field