GREEN POWER PROGRAM REBATE APPLICATION Type of Rebate Residential Business/Commercial Applicant Info Applicant Name First Name Last Name Name on Electric Account, if Different Mailing Address Address Address 2 City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Phone Email Contact Person Renewable Energy System Info Installation Address Address Address 2 City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code More Enter physical location of renewable energy system Nameplate Capacity Attach a complete material list (with costs) for the project's installation Upload Upload requirementsOne file only.50 MB limit.Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip. List all other sources of funding for the project Do you give permission for MPE to photograph, publicize and/or provide signage for your installation (once completed) and allow a public tour? Yes No List all energy efficiency measures that you have adopted at this location prior to installation of your renewable system. For what reason(s) did you install your renewable energy system? How far from a public road is your renewable energy system? Which Road? Please provide the name & contact information for your installer. Date your system became operational. PV Watts Report Upload, if installing solar - https://pvwatts.nrel.gov (Required for solar) Upload Upload requirementsOne file only.50 MB limit.Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip. Installation Latitude Installation Longitude Green Power Info Are you currently a Green Power Program contributor, purchasing $1 blocks from MPE? (NOTE: To qualify for a rebate, you must contribute. If you are not yet a contributor, please fill out and submit the GREEN POWER CONTRIBUTION FORM or call MPE). Yes No How many blocks? Have you received a green power rebate from MPE before? Yes No Status message Rebate Application Processing Rebates will be considered upon completion of installation and operation of your renewable energy system. Upon emailing this form, the applicant warrants and represents that the information provided is true and complete until a written notice of change is provided. The applicant also agrees that the Mountain Parks Electric Green Power Advisory Committee is authorized to make inquires deemed necessary to validate the rebate application's accuracy. All information included in your rebate application will be used for the sole purpose of determining whether or not to award the project rebate dollars. Submit
