| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 2025-81130661 | 05/26/2026 | Conger LP | Debora Simning | (229) 776-7336 | Email hidden; Javascript is required. | Submitted | 05/19/2026 | 05/19/2026 | James Seabolt | New Construction | $200.00 | 1 | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Rinnai | RE180e | TL.UA-163730 | 05/19/2026 | $200.00 | Conger LP | Debora Simning | 306 S Main St Sylvester, Georgia 31791 Map It | Email hidden; Javascript is required. | (229) 776-7336 | Marcus Fletcher Construction | (229) 347-0845 | Email hidden; Javascript is required. | 129 N Main St Sylvester, Georgia 31791 Map It | Marcus Fletcher Const 824 Jones Rd TyTy, Georgia 31795 Map It | Marcus Fletcher Construction | |||||||||||||||||||
| 2025-27856345 | 05/26/2026 | Folger Gas | Heather Marchman | (706) 367-8782 | Email hidden; Javascript is required. | Submitted | 05/22/2026 | 05/22/2026 | Owen Dills | New Construction | $650.00 | 3 | Propane-Fueled Recirculating Water Heater ($400.00) | Rinnai | RXP199 | TJ.BA-217296 | 05/22/2026 | img20260526_10133295.pdf | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Rinnai | RX160i | TH.BA-194576 | 05/22/2026 | img20260526_101332951.pdf | Cooktop ($50.00) | Wolf | DF48650GSPLP | 28017495 | 05/22/2026 | img20260526_101332952.pdf | $650.00 | Folger Gas | Heather Marchman | 1950 Bill Wright Road Jefferson, Georgia 30549 Map It | Email hidden; Javascript is required. | (706) 367-8782 | Kevin Anderson | (706) 614-9407 | 620 Payneville Road Jefferson, Georgia 30549 Map It | 620 Payneville Road Jefferson, Georgia 30549 Map It | N/A | |||||||
| 2025-83668471 | 05/26/2026 | Conger LP gas Moultrie | Kyle Johnson | (229) 985-6942 | Email hidden; Javascript is required. | Submitted | 05/20/2026 | 05/20/2026 | Conner Seabolt | Replacement or New Appliance | $200.00 | 1 | New Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Rinnai | RE180EP | WC.UA-023209 | 05/20/2026 | 4238_260526111657_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 | Rob Jones | (229) 456-7999 | P.O. Box 180 Norman Park, Georgia 31771 Map It | 431 Moye Rd Norman Park, Georgia 31771 Map It | 4238_260526111657_0011.pdf | ||||||||||||||||||
| 2025-93631389 | 05/26/2026 | Folger Gas | Heather Marchman | (706) 367-8782 | Email hidden; Javascript is required. | Submitted | 05/22/2026 | 05/22/2026 | Kevin Smoot | New Construction | $50.00 | 1 | Cooktop ($50.00) | Frigidaire | FFGF3053LSF | VF13141855 | 05/22/2026 | img20260526_11452114.pdf | $50.00 | Folger Gas | Heather Marchman | 1950 Bill Wright Road Jefferson, Georgia 30549 Map It | Email hidden; Javascript is required. | (706) 367-8782 | Stephen Byerly | (770) 833-9526 | 1413 Wood Fern Way Bogart, Georgia 30622 Map It | 1413 Wood Fern Way Bogart, Georgia 30622 Map It | N/A | |||||||||||||||||||
| 2025-71307104 | 05/26/2026 | Conger LP gas Moultrie | Kyle Johnson | (229) 985-6942 | Email hidden; Javascript is required. | Submitted | 05/20/2026 | 05/20/2026 | Conner Seabolt | Replacement or New Appliance | $200.00 | 1 | New Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Rinnai | RX199IN | TG.BA-156858 | 05/20/2026 | 4239_260526123314_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 | Michael Sumler | (229) 305-2557 | Email hidden; Javascript is required. | 1750 Smithwich Bridge Rd Moultrie, Georgia 31768 Map It | 1750 Smithwich Bridge Rd Moultrie, Georgia 31768 Map It | 4239_260526123314_0011.pdf | |||||||||||||||||
| 2025-88552756 | 05/26/2026 | Conger LP Gas | KAYLEA SMITH | (229) 469-4250 | Email hidden; Javascript is required. | Submitted | 05/06/2026 | 05/06/2026 | Seth Weeks | Replacement or New Appliance | $200.00 | 1 | Replacement Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Rinnai | RE180eP | TL.UA-163729 | 05/06/2026 | TOWN-6013_0833_260526135255_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 | Town and Country Investments | (229) 460-5113 | Email hidden; Javascript is required. | PO Box 307 Lakeland, Georgia 31635 Map It | 6013 4-H Club Road Lake Park, Georgia 31636 Map It | TOWN-6013_0833_260526135255_0011.pdf | |||||||||||||||||
| 2025-62362762 | 05/26/2026 | Conger LP Gas | KAYLEA SMITH | (229) 469-4250 | Email hidden; Javascript is required. | Submitted | 05/20/2026 | 05/20/2026 | Cole Truett | Replacement or New Appliance | $200.00 | 1 | Replacement Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Rinnai | RE160eP | WD.UA-038717 | 05/20/2026 | JMC-3305_0832_260526135213_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 | JMC Construction | (229) 506-0375 | Email hidden; Javascript is required. | 78 Carters Mill Road Barney, Georgia 31625 Map It | 3305 Plantation Drive Valdosta, Georgia 31605 Map It | JMC-3305_0832_260526135213_0011.pdf | |||||||||||||||||
| 2025-21376314 | 05/27/2026 | Folger Gas | Stacy Mullinax | (706) 632-7606 | Email hidden; Javascript is required. | Submitted | 05/22/2026 | 05/22/2026 | Alvin Wilcox | New Construction | $400.00 | 1 | Propane furnace, or gas pack ($400.00) | Carrier | R92MSN07801716A1 | A253064993 | 05/22/2026 | img05272026_0003.pdf | $400.00 | Folger Gas | Stacy Mullinax | 4955 Appalachian Highway Blue Ridge, Georgia 30513 Map It | Email hidden; Javascript is required. | (706) 632-7606 | Anthony Falls | (706) 455-1216 | Email hidden; Javascript is required. | 171 Mount Angelico Road Murphy, North Carolina 28906 Map It | 66 Woodland Trail Epworth, Georgia 30541 Map It | Anthony Falls | ||||||||||||||||||
| 2025-19892064 | 05/27/2026 | Conger LP GAS | christina Duncan | (912) 537-8722 | Email hidden; Javascript is required. | Submitted | 05/26/2026 | 04/30/2026 | Jonathan Mauldin | New Construction | $200.00 | 1 | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Rinnai | RE160EP | WB.UA-012887 | 04/30/2026 | COOPER.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 | Fred Cooper | (912) 399-0488 | 5349 Old Surrency Rd Surrency, Georgia 31563 Map It | 5349 Old Surrency Rd Surrency, Georgia 31563 Map It | Mckenzie Builders Greg | |||||||||||||||||||
| 2025-73763935 | 05/27/2026 | Conger LP Gas | KAYLEA SMITH | (229) 469-4250 | Email hidden; Javascript is required. | Submitted | 05/22/2026 | 05/22/2026 | Seth Weeks | Replacement or New Appliance | $200.00 | 1 | Replacement Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Rinnai | RE180eP | WA.UA-004311 | 05/22/2026 | PREMIER-5061_0851_260527144125_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 | Premier Southern | (229) 563-1602 | Email hidden; Javascript is required. | 2410 Andover Drive Valdosta, Georgia 31602 Map It | 5061 Bethany Hahira, Georgia 31632 Map It | PREMIER-5061_0851_260527144125_0011.pdf | |||||||||||||||||
| 2025-58988308 | 05/27/2026 | Conger LP Gas | KAYLEA SMITH | (229) 469-4250 | Email hidden; Javascript is required. | Submitted | 05/21/2026 | 05/21/2026 | Cole Truett | Replacement or New Appliance | $200.00 | 1 | Replacement Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Rinnai | RE160eP | WD.UA-038707 | 05/21/2026 | OWENS-571_0848_260527143943_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 | Owens Vinyl | (229) 482-3375 | Email hidden; Javascript is required. | 14 Murray Blvd Lakeland, Georgia 31635 Map It | 591 Old Valdosta Hwy Hahira, Georgia 31632 Map It | OWENS-571_0848_260527143943_0011.pdf | |||||||||||||||||
| 2025-52718237 | 05/27/2026 | Conger LP Gas | KAYLEA SMITH | (229) 469-4250 | Email hidden; Javascript is required. | Submitted | 05/21/2026 | 05/21/2026 | Cole Truett | Replacement or New Appliance | $200.00 | 1 | Replacement Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Rinnai | RE160eP | WD.UA-038727 | 05/21/2026 | OWENS-456_0849_260527144015_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 | Owens Vinyl | (229) 482-3375 | Email hidden; Javascript is required. | 14 Murray Blvd Lakeland, Georgia 31635 Map It | 456 Patten Watson Road Nashville, Georgia 31639 Map It | OWENS-456_0849_260527144015_0011.pdf | |||||||||||||||||
| 2025-76377393 | 05/27/2026 | Conger LP Gas | KAYLEA SMITH | (229) 469-4250 | Email hidden; Javascript is required. | Submitted | 05/21/2026 | 05/21/2026 | Cole Truett | Replacement or New Appliance | $200.00 | 1 | Replacement Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Rinnai | RE160eP | WD.UA-038711 | 05/21/2026 | OWENS-619_0850_260527144047_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 | Owens Vinyl | (229) 482-3375 | Email hidden; Javascript is required. | 14 Murray Blvd Lakeland, Georgia 31635 Map It | 619 Old Valdosta Hwy Hahira, Georgia 31632 Map It | OWENS-619_0850_260527144047_0011.pdf | |||||||||||||||||
| 2025-62104731 | 05/27/2026 | Modern Gas Company, Inc. | Mark Holloway | (229) 435-6116 | Email hidden; Javascript is required. | Submitted | 05/18/2026 | 05/18/2026 | MIKE BURLESON | Replacement or New Appliance | $200.00 | 1 | New Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RX180IN/P | TL.BA-260953 | 05/18/2026 | WATERS.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 | DEBBIE WATERS | (229) 322-1399 | 562 N SPRING CREEK CIRCLE COBB, Georgia 31735 Map It | 562 N SPRING CREEK CIRCLE COBB, Georgia 31735 Map It | WATERS1.pdf | ||||||||||||||||||
| 2025-70087557 | 05/27/2026 | Modern Gas Company, Inc. | Mark Holloway | (229) 435-6116 | Email hidden; Javascript is required. | Submitted | 05/11/2026 | 05/11/2026 | ROYCE HUNTER | New Construction | $200.00 | 1 | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RE160IP | SD.UA-058944 | 05/11/2026 | PURVIS-CONST.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 | C PURVIS CONSTRUCTION | (229) 308-9204 | 1662 NEW YORK ROAD LEESBURG, Georgia 31763 Map It | 1662 NEW YORK ROAD LEESBURG, Georgia 31763 Map It | C PURVIS CONSTRUCTION | |||||||||||||||||||
| 2025-83052662 | 05/27/2026 | Modern Gas Company, Inc. | Mark Holloway | (229) 435-6116 | Email hidden; Javascript is required. | Submitted | 05/13/2026 | 05/13/2026 | ROYCE HUNTER | Replacement or New Appliance | $200.00 | 1 | New Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RX199IN/P | WA.BA-004649 | 05/13/2026 | TOOLE.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 | DEE TOOLE | (229) 344-6045 | 663 BRIM ROAD DAWON, Georgia 39842 Map It | 663 BRIM ROAD DAWON, Georgia 39842 Map It | TOOLE1.pdf | ||||||||||||||||||
| 2025-53244787 | 05/27/2026 | Modern Gas Company, Inc. | Mark Holloway | (229) 435-6116 | Email hidden; Javascript is required. | Submitted | 05/14/2026 | 05/14/2026 | ROYCE HUNTER | Replacement or New Appliance | $200.00 | 1 | New Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RX160IN/P | TG.BA-175363 | 05/14/2026 | BRADY.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 | JACO WADE BRADY | (229) 854-7510 | 1369 YORK ROAD SYLVESTER, Georgia 31791 Map It | 1369 YORK ROAD SYLVESTER, Georgia 31791 Map It | BRADY1.pdf | ||||||||||||||||||
| 2025-27996292 | 05/27/2026 | Modern Gas Company, Inc. | Mark Holloway | (229) 435-6116 | Email hidden; Javascript is required. | Submitted | 05/18/2026 | 05/18/2026 | MIKE BURLESON | New Construction | $400.00 | 2 | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RX160IN/P | TG.BA-155935 | 05/18/2026 | MCDONALD-CONST.pdf | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RX160IN/P | TG.BA-155808 | 05/18/2026 | MCDONALD-CONST1.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 | CHAD MCDONALD CONSTRUCTION | (229) 881-9477 | 535 GATOR POND RD SMITHVILLE, Georgia 31787 Map It | 535 GATOR POND RD SMITHVILLE, Georgia 31787 Map It | CHAD MCDONALD CONSTRUCTION | |||||||||||||
| 2025-16205915 | 05/27/2026 | Modern Gas Company, Inc. | Mark Holloway | (229) 435-6116 | Email hidden; Javascript is required. | Submitted | 05/21/2026 | 05/21/2026 | RICKY JARRELL | Replacement or New Appliance | $200.00 | 1 | Replacement Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | AO SMITH | GCR50 401 | 2518143545820 | 05/21/2026 | Gehlot.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 | ROSY GEHLOT | (229) 894-9699 | 117 LARKSPUR DRIVE ALBANY, Georgia 31721 Map It | 117 LARKSPUR DRIVE ALBANY, Georgia 31721 Map It | Gehlot1.pdf | ||||||||||||||||||
| 2025-51630048 | 05/28/2026 | Folger Gas | Heather Marchman | (706) 367-8782 | Email hidden; Javascript is required. | Submitted | 05/27/2026 | 05/27/2026 | Kevin Smoot | New Construction | $50.00 | 1 | Cooktop ($50.00) | KitchenAid | KECK366VSS00 | XW2303492 | 05/27/2026 | img20260528_10285492.pdf | $50.00 | Folger Gas | Heather Marchman | 1950 Bill Wright Road Jefferson, Georgia 30549 Map It | Email hidden; Javascript is required. | (706) 367-8782 | James Kendrick | (571) 420-4566 | 7071 Sanctuary Drive Jefferson, Georgia 30549 Map It | 7071 Sanctuary Drive Jefferson, Georgia 30549 Map It | N/A | |||||||||||||||||||
| 2025-37086362 | 05/28/2026 | Conger LP | Debora Simning | (229) 776-7336 | Email hidden; Javascript is required. | Submitted | 05/26/2026 | 05/26/2026 | James Seabolt | New Construction | $200.00 | 1 | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Rin | RE180e | TL.UA-176130 | 05/26/2026 | $200.00 | Conger LP | Debora Simning | 306 S Main St Sylvester, Georgia 31791 Map It | Email hidden; Javascript is required. | (229) 776-7336 | Marcus Fletcher Construction | (229) 347-0845 | Email hidden; Javascript is required. | 129 N Main St Sylvester, Georgia 31791 Map It | Marcus Fletcher Construction 824 Creekwood Circle TY TY, Georgia 31795 Map It | Marcus Fletcher Construction | |||||||||||||||||||
| 2025-39623097 | 05/28/2026 | Conger LP Gas | Lee Phillips | (229) 386-5574 | Email hidden; Javascript is required. | Submitted | 05/07/2026 | 05/07/2026 | Landon Dotson | Replacement or New Appliance | $200.00 | 1 | Replacement Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Rinnai | RE160eP | TG.UA-098160 | 05/07/2026 | 3346_001.pdf | $200.00 | Conger LP Gas | Lee Mathews | 146 S. RIDGE AVE. TIFTON, Georgia 31794 Map It | Email hidden; Javascript is required. | (229) 386-5574 | Aubrey Thompson | (229) 382-6458 | Email hidden; Javascript is required. | 126 Cedar Ridge Rd. Tifton, Georgia 31794 Map It | 126 Cedar Ridge Rd. Tifton, Georgia 31794 Map It | 3346_0011.pdf | |||||||||||||||||
| 2025-46788794 | 05/29/2026 | Modern Gas Company, Inc. | Mark Holloway | (229) 435-6116 | Email hidden; Javascript is required. | Submitted | 05/12/2026 | 05/12/2026 | CURTIS HUNTER | Replacement or New Appliance | $200.00 | 1 | New Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RE180EP | WC.UA-026856 | 05/12/2026 | CALLAWAY.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 | PAT CALLAWAY | (229) 308-9304 | 6941 WASHINGTON ST PRESTON, Georgia 31824 Map It | 6941 WASHINGTON ST PRESTON, Georgia 31824 Map It | CALLAWAY1.pdf | ||||||||||||||||||
| 2025-81161453 | 05/29/2026 | Modern Gas Company, Inc. | Mark Holloway | (229) 435-6116 | Email hidden; Javascript is required. | Submitted | 05/14/2026 | 05/14/2026 | ROYCE HUNTER | Replacement or New Appliance | $200.00 | 1 | New Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RX160IN/P | TG.BA-158375 | 05/14/2026 | HOLBROOK.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 | TIM HOLBROOK | (239) 595-4144 | 363 MARTINDALE DR ALBBANY, Georgia 31721 Map It | 363 MARTINDALE DR ALBBANY, Georgia 31721 Map It | HOLBROOK1.pdf | ||||||||||||||||||
| 2025-22066994 | 05/29/2026 | Modern Gas Company, Inc. | Mark Holloway | (229) 435-6116 | Email hidden; Javascript is required. | Submitted | 05/26/2026 | 05/26/2026 | ROYCE HUNTER | Replacement or New Appliance | $200.00 | 1 | New Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RX160IN/P | TJ.BA-211132 | 05/26/2026 | MOORE.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 | COLBY MOORE | (229) 344-3561 | 2906 OLD FLOWING WELL RD LEESBURG, Georgia 31763 Map It | 2906 OLD FLOWING WELL RD LEESBURG, Georgia 31763 Map It | MOORE1.pdf | ||||||||||||||||||
| 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 |
