Plumas-Sierra Solar Program

2009 Rebate Application

Member Information
Member Name:
Installation Address:
Phone #: Email:
PSREC Account #: # KWh used in last 12 months:
System Seller Information
Company: Address:
Phone #: Email:
Installer Information Check if Same as Seller
Company and Contact Name:
Duration of the warranty on major parts (modules & inverter) and labor:
Phone #: Email:
Contractor Class: License #: Expires:
PV System Information Check if system is not roof mounted & include plot plan (see Guidebook)
Module Manufacturer: Module Model #:
Quantity: CEC Power Rating Total Module Output
per Module: Watts (quantity x power rating): WattsDC
Inverter Manufacturer: Inverter Model #:
Quantity: CEC Inverter Efficiency Rating:
System Output
System Output (total module output x inverter efficiency): WattsAC
Orientation: Tilt:
Average Annual Solar Access (%): Specify method of Shade Analysis:
Shade-discounted System Output Estimated Energy Production:
(system output x % av. annual solar access): WattsAC kWh/year
Installed System Cost (Attach copy of itemized purchase order for equipment and installation)
Total Cost of System Before Rebate or Tax Credits: $
Rebate Pay rebate to: Member Seller
Eligible Rebate: $ ($2.60/wattAC x shade-discounted system output), maximum $6,000
Each of the Undersigned declares under penalty of perjury that:
• The information provided in this form is true and correct to the best of my knowledge,
• The PV system is intended to offset part or all of the your electric needs at the site of installation,
• The site of installation is located within Plumas-Sierra REC service territory,
• Your intent is to operate the system at the listed site of installation for its useful life, and
• If you trench, you agree to disclose the location of easements and call 811 to “Call Before You Dig”.

Member Signature Date

Seller Signature Date

PVrebateAp2009-123108