311 E.

Wilcox Drive ∙ Sierra Vista, AZ 85635

Rebate Reservation Request Form

When this form is completed and signed by the member and received by Sulphur Springs Valley Electric
Cooperative, Inc. (SSVEC), the member will be placed on the Sun Watts rebate reservation list until there are
sufficient monies to fund the rebate amount. The reservations are placed on the reservation list based on a first
come first serve basis. When the rebate monies to fund your system become available, the member will be
notified and has a 60 day period to begin the installation process.

If an SSVEC member chooses to install their system before they are notified that funds are available, they must
still complete the reservation form and in addition must complete the installation application forms and submit
the entire completed packet to SSVEC. The date that the reservation form is received by SSVEC will be the
date that they are placed on the reservation list which will determine when they receive the rebate.

Customer Name: ______________________________________________________________________

Customer Address: ____________________________________________________________________

____________________________________________________________________________________

Phone number: ____________________________ Alternate Phone: ____________________________

System Type: Solar PV Solar Water Wind Other ____________________________

Residential installation Commercial installation

Proposed System Size: Rebate Reserved: ___________________________

Customer signature:_________________________________________ Date: _____________________

Received by: ______________________________________________ Date: _____________________

(Cooperative employee)

SSVEC Office Use:

Customer Account #: Rebate Reserved: ________________ Date placed on reservation list: ______________

Reserved rebate processed or forfeited Date:___________ By: ___________________________

January 2010