| Invoice # | Today's Date | Company Name | Company Contact | Company Phone | Company Email | Rebate Status | Safety Inspection Date | Purchase/Invoice Date | Safety Inspector’s Full Name | Type of Installation | Total | How many rebates would you like to claim? | Installation Type | Appliance Type | Brand | Model # | Model # | Serial Number | Installation Date | Upload Receipt | Appliance Type | Brand | Model # | Model # | Serial Number | Installation Date | Upload Receipt | Appliance Type | Brand | Model # | Model # | Serial Number | Installation Date | Upload Receipt | Total | Propane Company Name | Propane Marketer Name | Mailing Address | Email Address | Phone Number | Customer / Recipient Name | Customer / Recipient Phone Number | Customer / Recipient Email | Customer / Recipient Address | Customer / Recipient Installation Address | Upload Proof of Purchase: | Name of Builder/Contractor | Upload Spec Sheet for Manufactured Home |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 2025-65697945 | 04/01/2026 | Fitzgerald Utilities | Cecilia Smith | (229) 426-5440 | Email hidden; Javascript is required. | Payment Sent | 03/31/2026 | 03/30/2026 | CHRIS WOODS | Replacement or New Appliance | $200.00 | 1 | Conversion | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RE180EP | TL.UA 161562 | 03/31/2026 | M-Howell_0001.pdf | $200.00 | FITZGERALD UTILITIES | JUSTIN SUMNER | P.O. BOX 667 122 N MAIN STREET FITZGERALD, Georgia 31750 Map It | Email hidden; Javascript is required. | (229) 426-5440 | MARK HOWELL | (229) 457-1801 | 178 GARDENIA LANE FITZGERALD, Georgia 31750 Map It | 178 GARDENIA LANE FITZGERALD, Georgia 31750 Map It | M-Howell_00011.pdf | ||||||||||||||||||
| 2025-23085455 | 04/01/2026 | Conger LP gas Moultrie | Kyle Johnson | (229) 985-6942 | Email hidden; Javascript is required. | Payment Sent | 03/19/2026 | 03/19/2026 | Taylor Newsome | Replacement or New Appliance | $200.00 | 1 | New Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Rinnai | RE180EP | EC.UA-023205 | 03/19/2026 | 3806_260331164926_001.pdf | $200.00 | Conger LP Gas Moultrie | Kyle Johnson | 3117 veterans parkway s Moultrie, Georgia 31768 Map It | Email hidden; Javascript is required. | (229) 985-6942 | Sandra Crouch | (207) 570-4375 | Email hidden; Javascript is required. | 311 CM Chafin Rd Norman Park, Georgia 31771 Map It | 311 CM Chafin Rd Norman Park, Georgia 31771 Map It | 3806_260331164926_0011.pdf | |||||||||||||||||
| 2025-72577990 | 04/02/2026 | Conger LP Gas | KAYLEA SMITH | (229) 469-4250 | Email hidden; Javascript is required. | Payment Sent | 03/30/2026 | 03/30/2026 | Matthew Ray | Replacement or New Appliance | $200.00 | 1 | Replacement Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Rinnai | RE180eP | TM.UA-172946 | 03/30/2026 | NEWSOME-120_0344_260402112536_001.pdf | $200.00 | Conger LP Gas | Richard McCranie | 2310 US Hwy 84 W Suite B Valdosta, Georgia 31601 Map It | Email hidden; Javascript is required. | (229) 469-4250 | Chris Newsome | (229) 292-1990 | Email hidden; Javascript is required. | 120 Sanders Road Hahira, Georgia 31632 Map It | 120 Sanders Road Hahira, Georgia 31632 Map It | NEWSOME-120_0344_260402112536_0011.pdf | |||||||||||||||||
| 2025-95320723 | 04/02/2026 | Modern Gas Company, Inc. | Mark Holloway | (229) 435-6116 | Email hidden; Javascript is required. | Payment Sent | 03/24/2026 | 03/24/2026 | ROYCE HUNTER | Replacement or New Appliance | $200.00 | 1 | New Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RE180EP | TL.UA-161558 | 03/24/2026 | williams.pdf | $200.00 | MODERN GAS COMPANY | MARK HOLLOWAY | 1335 US HWY 82 EST LEESBURG, Georgia 31763 Map It | Email hidden; Javascript is required. | (229) 435-6116 | ANTHONY WILLIAMS | (229) 344-4599 | 102 NORTHAMPTON RD LEESBURG, Georgia 31763 Map It | 102 NORTHAMPTON RD LEESBURG, Georgia 31763 Map It | williams1.pdf | ||||||||||||||||||
| 2025-64412522 | 04/02/2026 | Modern Gas Company, Inc. | Mark Holloway | (229) 435-6116 | Email hidden; Javascript is required. | Payment Sent | 03/25/2026 | 03/25/2026 | royce hunter | Replacement or New Appliance | $200.00 | 1 | New Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RE160EP | TJ.UA-132969 | 03/25/2026 | halstead.pdf | $200.00 | MODERN GAS COMPANY | MARK HOLLOWAY | 1335 US HWY 82 EST LEESBURG, Georgia 31763 Map It | Email hidden; Javascript is required. | (229) 435-6116 | AUBREY HALSTEAD | (229) 347-7660 | 143 SWIFTCREEK RD CORDELE, Georgia 31015 Map It | 143 SWIFTCREEK RD CORDELE, Georgia 31015 Map It | halstead1.pdf | ||||||||||||||||||
| 2025-79285949 | 04/02/2026 | Webb Brothers Propane, Inc | Kristy Gamble | (229) 382-0789 | Email hidden; Javascript is required. | Payment Sent | 04/02/2026 | 04/02/2026 | ROBERT COTHREN | New Construction | $200.00 | 1 | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RE180EP | WA.UA-004017 | 04/02/2026 | MANNIE-AHMED.pdf | $200.00 | Webb Brothers Propane, Inc | Kristy Gamble | PO Drawer 7269 3615 Hwy 82 W Tifton, Georgia 31793 Map It | Email hidden; Javascript is required. | (229) 382-0789 | MANNIE AHMED | (973) 687-2986 | 10 LYNN LN OMEGA, Georgia 31774 Map It | 146 LAMAR ST OMEGA, Georgia 31774 Map It | OMEGA 786 ING | |||||||||||||||||||
| 2025-99620751 | 04/02/2026 | Modern Gas Company, Inc. | Mark Holloway | (229) 435-6116 | Email hidden; Javascript is required. | Payment Sent | 03/24/2026 | 03/24/2026 | MIKE BURLESON | Replacement or New Appliance | $400.00 | 2 | New Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RX199IN/P | TG.BA-165662 | 03/24/2026 | CASEY.pdf | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RX160IN/P | SK.BA-166553 | 03/24/2026 | CASEY1.pdf | $400.00 | MODERN GAS COMPANY | MARK HOLLOWAY | 1335 US HWY 82 EST LEESBURG, Georgia 31763 Map It | Email hidden; Javascript is required. | (229) 435-6116 | MATT CASEY | (229) 344-3171 | 2503 COOLEEWAHEE COVE ALBANY, Georgia 31721 Map It | 2503 COOLEEWAHEE COVE ALBANY, Georgia 31721 Map It | CASEY2.pdf | ||||||||||||
| 2025-77479634 | 04/02/2026 | Modern Gas Company, Inc. | Mark Holloway | (229) 435-6116 | Email hidden; Javascript is required. | Payment Sent | 03/27/2026 | 03/27/2026 | MIKE BURLESON | Replacement or New Appliance | $200.00 | 1 | New Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RE160EP | WB.UA-012034 | 03/27/2026 | SENKBEIL.pdf | $200.00 | MODERN GAS COMPANY | MARK HOLLOWAY | 1335 US HWY 82 EST LEESBURG, Georgia 31763 Map It | Email hidden; Javascript is required. | (229) 435-6116 | JOHN SENKBEIL | (229) 343-1587 | 2705 BRITTANY ROAD ALBANY, Georgia 31721 Map It | 2705 BRITTANY ROAD ALBANY, Georgia 31721 Map It | SENKBEIL1.pdf | ||||||||||||||||||
| 2025-23866839 | 04/02/2026 | Conger LP GAS | christina Duncan | (912) 537-8722 | Email hidden; Javascript is required. | Payment Sent | 03/31/2026 | 03/31/2026 | Jackson Hartley | Replacement or New Appliance | $200.00 | 1 | Replacement Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Rinnai | RE160EP | TJ.UA-132939 | 03/31/2026 | SEWELL.pdf | $200.00 | Conger LP GAS | Christina Duncan | 604 North Broadfoot Blvd Vidalia, Georgia 30474 Map It | Email hidden; Javascript is required. | (912) 537-8722 | Robert Sewell | (229) 548-1967 | 1695 Petross Rd Ailey, Georgia 30412 Map It | 1695 Petross Rd Ailey, Georgia 30412 Map It | SEWELL1.pdf | ||||||||||||||||||
| 2025-78681864 | 04/02/2026 | Sikes Propane Inc | Daniel Sikes Jr | (912) 367-1151 | Email hidden; Javascript is required. | Payment Sent | 03/27/2026 | 03/27/2026 | DANIEL SIKES | Replacement or New Appliance | $200.00 | 1 | New Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RE140e | TL.UA-168085 | 03/27/2026 | HPSCAN_20260402195709514_2026-04-02_195757314-compressed.pdf | $200.00 | SIKES PROPANE INC. | SIKES PROPANE | 2174 HATCH PARKWAY SOUTH BAXLEY, Georgia 31513 Map It | Email hidden; Javascript is required. | (912) 367-1151 | LUKE WHITE | (912) 339-3527 | 49 ZOARBELLA RD BAXLEY, Georgia 31513 Map It | 49 ZOARBELLA RD BAXLEY, Georgia 31513 Map It | HPSCAN_20260402195709514_2026-04-02_195757314-compressed1.pdf | ||||||||||||||||||
| 2025-25061133 | 04/02/2026 | Conger LP GAS | christina Duncan | (912) 537-8722 | Email hidden; Javascript is required. | Payment Sent | 03/23/2026 | 03/23/2026 | Jackson Hartley | Replacement or New Appliance | $200.00 | 1 | Replacement Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Rinnai | RE160EP | WB.UA-012014 | 03/23/2026 | BOWEN.pdf | $200.00 | Conger LP GAS | Christina Duncan | 604 North Broadfoot Blvd Vidalia, Georgia 30474 Map It | Email hidden; Javascript is required. | (912) 537-8722 | Ross Bowen | (404) 293-0822 | 1000 Darby Circle Vidalia, Georgia 30474 Map It | 1572 Ross Bowen Rd Lyons, Georgia 30436 Map It | BOWEN1.pdf | ||||||||||||||||||
| 2025-86818198 | 04/03/2026 | Conger LP gas Moultrie | Kyle Johnson | (229) 985-6942 | Email hidden; Javascript is required. | Payment Sent | 03/27/2026 | 03/27/2026 | Jordan Ledford | Replacement or New Appliance | $200.00 | 1 | Replacement Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Rinnai | RE199ep | TG.UA-112052 | 03/27/2026 | 3825_260403093449_001.pdf | $200.00 | Conger LP Gas Moultrie | Kyle Johnson | 3117 veterans parkway s Moultrie, Georgia 31768 Map It | Email hidden; Javascript is required. | (229) 985-6942 | Elica Alverado | (229) 589-1903 | Email hidden; Javascript is required. | 211 Circle Rd Moultrie, Georgia 31768 Map It | 204 Circle rd Moultrie, Georgia 31768 Map It | 3825_260403093449_0011.pdf | |||||||||||||||||
| 2025-57471865 | 04/03/2026 | Conger LP GAS | christina Duncan | (912) 537-8722 | Email hidden; Javascript is required. | Payment Sent | 03/26/2026 | 03/26/2026 | Jonathan Mauldin | Replacement or New Appliance | $200.00 | 1 | New Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Rinnai | RE160EP | WB.UA-012005 | 03/26/2026 | chubb.pdf | $200.00 | Conger LP GAS | Christina Duncan | 604 North Broadfoot Blvd Vidalia, Georgia 30474 Map It | Email hidden; Javascript is required. | (912) 537-8722 | Brandon Chubb | (912) 805-0618 | 1324 George Hill Rd Lyons, Georgia 30436 Map It | 1324 George Hill Rd Lyons, Georgia 30436 Map It | chubb1.pdf | ||||||||||||||||||
| 2025-28855171 | 04/03/2026 | Conger LP GAS | christina Duncan | (912) 537-8722 | Email hidden; Javascript is required. | Payment Sent | 03/13/2026 | 03/13/2026 | Jackson Hartley | New Construction | $200.00 | 1 | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Rinnai | RE180EP | TE.UA-063574 | 03/13/2026 | DICKERSON.pdf | $200.00 | Conger LP GAS | Christina Duncan | 604 North Broadfoot Blvd Vidalia, Georgia 30474 Map It | Email hidden; Javascript is required. | (912) 537-8722 | Michelle Dickerson | (912) 314-3417 | 17289 Union Rd Metter, Georgia 30439 Map It | 17289 Union Rd Metter, Georgia 30439 Map It | Foskey Construction | |||||||||||||||||||
| 2025-29359200 | 04/06/2026 | Conger LP gas Moultrie | Kyle Johnson | (229) 985-6942 | Email hidden; Javascript is required. | Payment Sent | 03/23/2026 | 03/23/2026 | Conner Seabolt | Replacement or New Appliance | $200.00 | 1 | Replacement Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Rinnia | RE180EP | WC.UA-023204 | 03/23/2026 | 3828_260403105219_001.pdf | $200.00 | Conger LP Gas Moultrie | Kyle Johnson | 3117 veterans parkway s Moultrie, Georgia 31768 Map It | Email hidden; Javascript is required. | (229) 985-6942 | Kayla Taylor | (229) 241-9747 | Email hidden; Javascript is required. | 436 Shade Murphy Rd Moultrie, Georgia 31768 Map It | 436 Shade Murphy Rd Moultrie, Georgia 31768 Map It | 3828_260403105219_0011.pdf | |||||||||||||||||
| 2025-80641979 | 04/06/2026 | Conger LP | Debora Simning | (229) 776-7336 | Email hidden; Javascript is required. | Payment Sent | 04/02/2026 | 04/02/2026 | James Seabolt | Replacement or New Appliance | $200.00 | 1 | New Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Rinnai | RX199i | TG.BA-170772 | 04/02/2026 |  | $200.00 | Conger LP | Debora Simning | 306 S Main St Sylvester, Georgia 31791 Map It | Email hidden; Javascript is required. | (229) 776-7336 | Jason Hendricks | (229) 392-1340 | Email hidden; Javascript is required. | Jason Hendricks 598 Lakeshore Dr Cordele, Georgia 31015 Map It | Jason Hendricks 598 Lakeshore Dr Cordele, Georgia 31015 Map It | ||||||||||||||||||
| 2025-70487320 | 04/06/2026 | HAROLDS PROPANE | HAROLD CAWTHON | (770) 775-4821 | Email hidden; Javascript is required. | Payment Sent | 03/30/2026 | 03/30/2026 | KEITH THOMPSON | Replacement or New Appliance | $200.00 | 1 | Replacement Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RHEEM | PROG40-32PRH62 | Q492504737 | 03/30/2026 | Scan_20260406-2.pdf | $200.00 | HAROLDS PROPANE | HC HAROLD CAWTHON | P.O.BOX 219 162 stark rd. Jackson, Georgia 30233 Map It | Email hidden; Javascript is required. | (404) 535-0997 | MARSHA HOLLAND | (770) 843-9663 | MARSHA HOLLAND 527 KEYS FERRY RD JACKSON, Georgia 30233 Map It | MARSHA HOLLAND 527 KEYS FERRY RD JACKSON, Georgia 30233 Map It | Scan_20260406-21.pdf | ||||||||||||||||||
| 2025-16554468 | 04/07/2026 | Folger Gas | Stacy Mullinax | (706) 632-7606 | Email hidden; Javascript is required. | Payment Sent | 03/31/2026 | 03/31/2026 | Brandon Payne | New Construction | $400.00 | 1 | Propane furnace, or gas pack ($400.00) | Rheem | RCFY36175TANM | W332547087 | 03/31/2026 | img04072026_0033.pdf | $400.00 | Folger Gas | Stacy Mullinax | 4955 Appalachian Highway Blue Ridge, Georgia 30513 Map It | Email hidden; Javascript is required. | (706) 632-7606 | Keith Sumner DBA Sumner Customer Mountain Homes | (706) 632-7606 | Email hidden; Javascript is required. | PO Box 2760 Blue Ridge, Georgia 30513 Map It | 55 Patterson Ln Blue Ridge, Georgia 30513 Map It | Keith Sumner Sumner Custom Homes | ||||||||||||||||||
| 2025-28699565 | 04/07/2026 | Folger Gas | Stacy Mullinax | (706) 632-7606 | Email hidden; Javascript is required. | Payment Sent | 04/03/2026 | 04/03/2026 | Brandon Payne | New Construction | $200.00 | 1 | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Navien | NPE240A2 | 2087D2590979A | 04/03/2026 | img04072026_0034.pdf | $200.00 | Folger Gas | Stacy Mullinax | 4955 Appalachian Highway Blue Ridge, Georgia 30513 Map It | Email hidden; Javascript is required. | (706) 632-7606 | Grady Turner | (706) 455-7060 | Email hidden; Javascript is required. | 431 Tomahawk Point Morganton, Georgia 30560 Map It | 239 Dillion Rd Morganton, Georgia 30560 Map It | n/a | ||||||||||||||||||
| 2025-79849072 | 04/07/2026 | Conger LP Gas | Charlie Vining | (912) 501-3009 | Email hidden; Javascript is required. | Submitted | 04/06/2026 | 04/06/2026 | Charlie Vining | New Construction | $400.00 | 1 | Propane-Fueled Recirculating Water Heater ($400.00) | Rinnai | REP199eP | TJ.UA-143217 | 04/06/2026 | JOHNSON-RINNAI-REBATE.pdf | $400.00 | Conger LP Gas | Charlie Vining | 217 Thompson Dr Douglas, Georgia 31533 Map It | Email hidden; Javascript is required. | (912) 501-3009 | Kristen Johnson | (912) 292-3972 | 551 Crosswinds Dr Douglas, Georgia 31535 Map It | 551 Crosswinds Dr Douglas, Georgia 31535 Map It | Chris Mill Homes | |||||||||||||||||||
| 2025-36451660 | 04/07/2026 | Franklin Propane Gas, Inc. | Mike Franklin | (478) 552-6667 | Email hidden; Javascript is required. | Payment Sent | 04/06/2026 | 04/06/2026 | Jonathan Franklin | New Construction | $200.00 | 1 | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Rinaii | RE180EP | TJ.UA-128341 | 04/06/2026 | Yoder-Receipt.pdf | $200.00 | Franklin Propane Gas | Mike Franklin | P O Box 5890 Sandersville, Georgia 31082 Map It | Email hidden; Javascript is required. | (478) 552-6667 | Richard Yoder | (478) 595-7455 | Email hidden; Javascript is required. | 961 Southlake Drive East Dublin, Georgia 31027 Map It | 961 Southlake Drive East Dublin, Georgia 31027 Map It | Franklin Propane Gas | ||||||||||||||||||
| 2025-38887887 | 04/08/2026 | Conger LP Gas | Charlie Vining | (912) 501-3009 | Email hidden; Javascript is required. | Submitted | 03/26/2026 | 01/16/2026 | Charlie Vining | Replacement or New Appliance | $200.00 | 1 | New Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RE160eP | TJ.UA132943 | 01/16/2026 | GEORGE-DAVIS-REBATE.pdf | $200.00 | Conger LP Gas | Charlie Vining | 217 Thompson Dr Douglas, Georgia 31533 Map It | Email hidden; Javascript is required. | (912) 501-3009 | George Davis | (912) 327-2023 | Email hidden; Javascript is required. | 3054 Ricketson Rd Pearson, Georgia 31642 Map It | 3054 Ricketson Rd Pearson, Georgia 31642 Map It | GEORGE-DAVIS-REBATE1.pdf | |||||||||||||||||
| 2025-66120669 | 04/08/2026 | Folger Gas | Heather Marchman | (706) 367-8782 | Email hidden; Javascript is required. | Submitted | 03/27/2026 | 03/27/2026 | Kevin Smoot | New Construction | $200.00 | 1 | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Suburban | SW10 DE | 131608330 | 03/27/2026 | img20260408_10342829.pdf | $200.00 | Folger Gas | Heather Marchman | 1950 Bill Wright Road Jefferson, Georgia 30549 Map It | Email hidden; Javascript is required. | (706) 367-8782 | Roxane Campbell | (706) 870-3887 | 44 Crows Lake Drive Lot 5 Jefferson, Georgia 30549 Map It | 44 Crows Lake Drive Lot 5 Jefferson, Georgia 30549 Map It | N/A | |||||||||||||||||||
| 2025-59317149 | 04/08/2026 | BATES GAS COMPANY | CHRSITINE FOWLER | (229) 436-5338 | Email hidden; Javascript is required. | Submitted | 04/06/2026 | 04/06/2026 | FLOYD BRANCH | Replacement or New Appliance | $200.00 | 1 | Replacement Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RE160EP | TG.UA-098186 | 04/06/2026 | JOHNSONREBATE.pdf | $200.00 | BATES GAS COMPANY | CHRSITINE FOWLER | 2703 SYLVESTER RD ALBANY, Georgia 31705 Map It | Email hidden; Javascript is required. | (229) 436-5338 | JEFF JOHNSON | (912) 389-7587 | 557 LAKESHORE WAY CORDELE, Georgia 31015 Map It | 557 LAKESHORE WAY CORDELE, Georgia 31015 Map It | JOHNSONREBATE1.pdf | ||||||||||||||||||
| 2025-16444053 | 04/08/2026 | Folger Gas | Heather Marchman | (706) 367-8782 | Email hidden; Javascript is required. | Submitted | 04/07/2026 | 04/07/2026 | Owen Dills | New Construction | $850.00 | 3 | Dual Fuel Heat Pump ($400.00) | Daikin | GM95961005CNAB | 2301291370 | 04/07/2026 | img20260408_14221036.pdf | Dual Fuel Heat Pump ($400.00) | Daikin | GR95920603DNAA | 2507271979 | 04/07/2026 | img20260408_142210361.pdf | Cooktop ($50.00) | Cafe | CGP95362M351 | MA036330Q | 04/07/2026 | img20260408_142210362.pdf | $850.00 | Folger Gas | Heather Marchman | 1950 Bill Wright Road Jefferson, Georgia 30549 Map It | Email hidden; Javascript is required. | (706) 367-8782 | Carlton Sharpe | (770) 868-6892 | 621 Westminster Drive Athens, Georgia 30607 Map It | 621 Westminster Drive Athens, Georgia 30607 Map It | N/A | |||||||
| Invoice # | Today's Date | Company Name | Company Contact | Company Phone | Company Email | Rebate Status | Safety Inspection Date | Purchase/Invoice Date | Safety Inspector’s Full Name | Type of Installation | Total | How many rebates would you like to claim? | Installation Type | Appliance Type | Brand | Model # | Model # | Serial Number | Installation Date | Upload Receipt | Appliance Type | Brand | Model # | Model # | Serial Number | Installation Date | Upload Receipt | Appliance Type | Brand | Model # | Model # | Serial Number | Installation Date | Upload Receipt | Total | Propane Company Name | Propane Marketer Name | Mailing Address | Email Address | Phone Number | Customer / Recipient Name | Customer / Recipient Phone Number | Customer / Recipient Email | Customer / Recipient Address | Customer / Recipient Installation Address | Upload Proof of Purchase: | Name of Builder/Contractor | Upload Spec Sheet for Manufactured Home |
