LIPA 2010 EFFICIENT SWIMMING POOL PUMP PROGRAM

CUSTOMER REBATE FORM

In an effort to increase the installation of energy efficient residential swimming pool pumps on Long Island, LIPA is offering
a mail-in rebate to LIPA electric account customers who purchase a two-speed or variable speed swimming pool pump and
eligible controller.* Pool pumps must be installed by a participating dealer within the LIPA electric service area in 2010 to
be eligible for rebate. Eligible pumps must be 1/2 HP or larger. Retrofit and new construction customers are eligible.

LIPA Rebate for Two-Speed Pool Pumps with controller* = $75.00

LIPA Rebate for Variable Speed Pool Pumps with controller* = $200.00
Limit: One pool pump rebate per electric customer account.

The following criteria must be met in order to qualify for reimbursement:

1) Customer must have an electric account with LIPA.
2) Participating dealer/installer must have signed a LIPA 2010 Dealer/Installer Letter of Agreement.
3) Purchases and installations must be made between 1/1/10 and 12/31/10.
4) Customer Rebate Form must be completed in full.
5) Customer Rebate Form must be postmarked by 1/31/11.
POOL PUMP INFORMATION: (Please select pump type and complete product information below)
Pump Type LIPA Rebate Manufacturer Model # HP
Two-Speed $75.00
Variable Speed $200.00

CUSTOMER INFORMATION / INSTALLATION ADDRESS:

LIPA Customer Name Home Tel. Work Tel.

LIPA Electric Customer Account Number Mailing Address, if different (for rebate check)

Street LIPAedge Customer? Yes No

LIPAedge customers: Please contact the LIPAedge Hotline at
1-866-LIPAedge (1-866-547-2334) for information on how this
City State Zip Code
rebate will affect your status.

PARTICIPATING DEALER / INSTALLER INFORMATION: POOL INSTALLATION INFORMATION:

Date of Pool Pump Installation: _____/_____/____

Business Name
INSTALLATION TYPE: New Pump Replacement Pump

Street Address POOL TYPE: In Ground Above Ground

POOL SIZE: (gallons)

City State Zip Code
10,000-14,000 20,000-26,000 35,000-39,000
15,000-19,000 27,000-34,000 40,000-49,000
Installer’s Name (Print First, Last) Installer’s Signature
If 50,000 or larger please enter size here: _________________________

Mailing Address CONTROLLER TYPE: Existing Installed

CONTROLLER SYSTEM: Internal External

Phone Fax
If External Controller please include:

REDEMPTION INFORMATION: Please send completed Customer

Rebate Form plus copy of sales receipt and/or invoice showing Brand Model #
purchase price, purchase date, manufacturer, and model number of
the two-speed or variable speed pool pump purchased to: *IMPORTANT CONTROLLER INFORMATION:
Pool pump motor control must have the capability of operating at a
LIPA Pool Pump Rebate minimum of two speeds. The control’s default circulation speed setting
shall be no more than one-half of the motor’s maximum rotation rate.
40 Washington Street, Suite 2000
Any high speed override capability shall be for a temporary period not
Westborough, MA 01581-1013
to exceed one 24-hour cycle without resetting to default settings.

Questions? Please call 877-654-5472