| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 2025-54180921 | 06/24/2026 | Folger Gas | Stacy Mullinax | (706) 632-7606 | Email hidden; Javascript is required. | Payment Sent | 06/18/2026 | 06/18/2026 | Alex Cash | New Construction | $600.00 | 2 | Propane furnace, or gas pack ($400.00) | Train | EL297NG070XW | 5925H20467 | 06/18/2026 | img06242026_0016.pdf | Propane-Fueled Non-Recirculating Water Heater ($200.00) | NAVIEN | NPE24052 | 2099E251469F27 | 06/18/2026 | img06242026_00161.pdf | $600.00 | Folger Gas | Stacy Mullinax | 4955 Application Hwy Blue Ridge, Georgia 30513 Map It | Email hidden; Javascript is required. | (706) 632-7606 | Darren Impemba | (754) 224-7930 | Email hidden; Javascript is required. | 1617 Mountain Creek Hollow Rd Talking Rock, Georgia 30175 Map It | 1617 Mountain Creek Hollow Rd Talking Rock, Georgia 30175 Map It | N/A | ||||||||||||
| 2025-89046103 | 06/24/2026 | Folger Gas | Heather Marchman | (706) 367-8782 | Email hidden; Javascript is required. | Payment Sent | 06/22/2026 | 06/22/2026 | Kevin Smoot | New Construction | $400.00 | 1 | Propane-Fueled Recirculating Water Heater ($400.00) | Rinnai | RXP199 | TE-BA-172832 | 06/22/2026 | img20260624_13064202.pdf | $400.00 | Folger Gas | Heather Marchman | 1950 Bill Wright Road Jefferson, Georgia 30549 Map It | Email hidden; Javascript is required. | (706) 367-8782 | David Higgins | (404) 886-8372 | 1660 Mcree Gin Road Watkinsville, Georgia 30677 Map It | 1660 Mcree Gin Road Watkinsville, Georgia 30677 Map It | N/A | |||||||||||||||||||
| 2025-43636278 | 06/24/2026 | Folger Gas | Heather Marchman | (706) 367-8782 | Email hidden; Javascript is required. | Payment Sent | 06/23/2026 | 06/23/2026 | Kevin Smoot | New Construction | $50.00 | 1 | Cooktop ($50.00) | GE | PGF700AYIFJ | HD019320Q | 06/23/2026 | img20260624_13402752.pdf | $50.00 | Folger Gas | Heather Marchman | 1950 Bill Wright Road Jefferson, Georgia 30549 Map It | Email hidden; Javascript is required. | (706) 367-8782 | Alexandra Jenkins | (404) 424-6723 | 45 Spirit Lake Drive Pendergrass, Georgia 30567 Map It | 45 Spirit Lake Drive Pendergrass, Georgia 30567 Map It | N/A | |||||||||||||||||||
| 2025-19682767 | 06/24/2026 | Barfield Gas Company, Inc. | Michael Davis | (229) 896-4828 | Email hidden; Javascript is required. | Payment Sent | 06/02/2026 | 06/02/2026 | Caleb Harnage | Replacement or New Appliance | $200.00 | 1 | New Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RE140eP | WB.UA-010230 | 06/02/2026 | REBATE-CNORTON-57997.pdf | $200.00 | Barfield Gas Company | Michael Davis | PO BOX 990 PO BOX 990 Adel, Georgia 31620 Map It | Email hidden; Javascript is required. | (229) 896-4828 | CAREY NORTON | (229) 300-6999 | 785 LOVETT CIRCLE SPARKS, Georgia 31647 Map It | 785 LOVETT CIRCLE SPARKS, Georgia 31647 Map It | REBATE-CNORTON-579971.pdf | ||||||||||||||||||
| 2025-66789106 | 06/24/2026 | Barfield Gas Company, Inc. | Michael Davis | (229) 896-4828 | Email hidden; Javascript is required. | Payment Sent | 06/18/2026 | 06/17/2026 | Caleb Harnage | Replacement or New Appliance | $400.00 | 2 | New Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RE199eP | WC.UA-026403 | 06/18/2026 | REBATE-STONE-58042.pdf | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RE199eP | WC.UA-027723 | 06/18/2026 | REBATE-STONE-580421.pdf | $400.00 | Barfield Gas Company | Michael Davis | PO BOX 990 PO BOX 990 Adel, Georgia 31620 Map It | Email hidden; Javascript is required. | (229) 896-4828 | BRIAN STONE | (229) 896-2336 | 2206 EVERGREEN CHURCH RD ADEL, Georgia 31620 Map It | 2206 EVERGREEN CHURCH RD ADEL, Georgia 31620 Map It | REBATE-STONE-580422.pdf | ||||||||||||
| 2025-75231879 | 06/24/2026 | Barfield Gas Company, Inc. | Michael Davis | (229) 896-4828 | Email hidden; Javascript is required. | Payment Sent | 06/05/2026 | 06/05/2026 | Caleb Harnage | Replacement or New Appliance | $200.00 | 1 | New Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RE199eP | WC.UA-022652 | 06/05/2026 | REBATE-DTAYLORCONST-57791.pdf | $200.00 | Barfield Gas Company | Michael Davis | PO BOX 990 PO BOX 990 Adel, Georgia 31620 Map It | Email hidden; Javascript is required. | (229) 896-4828 | DIXON TAYLOR | (229) 506-0082 | 3073 HOUSER WAY HAHIRA, Georgia 31632 Map It | 3073 HOUSER WAY HAHIRA, Georgia 31632 Map It | REBATE-DTAYLORCONST-577911.pdf | ||||||||||||||||||
| 2025-99977763 | 06/24/2026 | Barfield Gas Company, Inc. | Michael Davis | (229) 896-4828 | Email hidden; Javascript is required. | Payment Sent | 06/02/2026 | 06/02/2026 | Caleb Harnage | Replacement or New Appliance | $200.00 | 1 | New Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RE140eP | WB.UA010230 | 06/02/2026 | REBATE-CNORTON-27997.pdf | $200.00 | Barfield Gas Company | Michael Davis | PO BOX 990 PO BOX 990 Adel, Georgia 31620 Map It | Email hidden; Javascript is required. | (229) 896-4828 | CAREY NORTON | (229) 300-6999 | 785 LOVETT CIRCLE SPARKS, Georgia 31647 Map It | 785 LOVETT CIRCLE SPARKS, Georgia 31647 Map It | REBATE-CNORTON-279971.pdf | ||||||||||||||||||
| 2025-13399402 | 06/24/2026 | Barfield Gas Company, Inc. | Michael Davis | (229) 896-4828 | Email hidden; Javascript is required. | Declined | 06/05/2026 | 06/05/2026 | Caleb Harnage | Replacement or New Appliance | $200.00 | 1 | New Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RE199eP | WC.UA-022652 | 06/05/2026 | REBATE-DTAYLORCONST-577912.pdf | $200.00 | Barfield Gas Company | Michael Davis | PO BOX 990 PO BOX 990 Adel, Georgia 31620 Map It | Email hidden; Javascript is required. | (229) 896-4828 | DIXON TAYLOR | (229) 506-0082 | 3073 HOUSER WAY HAHIRA, Georgia 31632 Map It | 3073 HOUSER WAY HAHIRA, Georgia 31632 Map It | REBATE-DTAYLORCONST-577913.pdf | ||||||||||||||||||
| 2025-13572559 | 06/25/2026 | Franklin Propane Gas, Inc. | Mike Franklin | (478) 552-6667 | Email hidden; Javascript is required. | Payment Sent | 06/24/2026 | 06/24/2026 | Jonathan Franklin | Replacement or New Appliance | $200.00 | 1 | Replacement Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Rinnai | RE180EP | TK.UA-157486 | 06/24/2026 | A-BROWN-REBATE-FORM.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 | Ana Brown | (478) 552-7652 | 105 Hardwood Hollow Sandersville, Georgia 31082 Map It | 105 Hardwood Hollow Sandersville, Georgia 31082 Map It | A-BROWN-REBATE-FORM1.pdf | ||||||||||||||||||
| 2025-37042054 | 06/25/2026 | Barfield Gas Company, Inc. | Michael Davis | (229) 896-4828 | Email hidden; Javascript is required. | Payment Sent | 06/18/2026 | 06/18/2026 | Caleb Harnage | Replacement or New Appliance | $200.00 | 1 | New Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RE199eP | WC.UA-027716 | 06/18/2026 | REBATE-ACEDEV-58038.pdf | $200.00 | Barfield Gas Company | Michael Davis | PO BOX 990 PO BOX 990 Adel, Georgia 31620 Map It | Email hidden; Javascript is required. | (229) 896-4828 | ACE DEVELOPMENT | (404) 656-2817 | 1565 COX STILL RD ADEL, Georgia 31620 Map It | 1565 COX STILL RD ADEL, Georgia 31620 Map It | REBATE-ACEDEV-580381.pdf | ||||||||||||||||||
| 2025-83032985 | 06/25/2026 | Modern Gas Company, Inc. | Mark Holloway | (229) 435-6116 | Email hidden; Javascript is required. | Payment Sent | 06/04/2026 | 06/04/2026 | TY BROWN | New Construction | $200.00 | 1 | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RE160IP | WD.UA-041798 | 06/04/2026 | COLEY.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 COLEY BUILDER | (229) 886-1212 | 213 TUPELO DRIVE LEESBURG, Georgia 31763 Map It | 213 TUPELO DRIVE LEESBURG, Georgia 31763 Map It | TIM COLEY BUILDER | |||||||||||||||||||
| 2025-40596364 | 06/25/2026 | Modern Gas Company, Inc. | Mark Holloway | (229) 435-6116 | Email hidden; Javascript is required. | Payment Sent | 06/23/2026 | 06/23/2026 | CURTIS HUNTER | Replacement or New Appliance | $200.00 | 1 | New Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | CX199IN/P | TJ.BA-217466 | 06/23/2026 | NEW-ERA.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 | NEW ERA CONVENIENCE STORE | (201) 486-9133 | 17636 N HIGHLAND AVE ARLINGTON, Georgia 39813 Map It | 17636 N HIGHLAND AVE ARLINGTON, Georgia 39813 Map It | NEW-ERA1.pdf | ||||||||||||||||||
| 2025-44400146 | 06/25/2026 | Modern Gas Company, Inc. | Mark Holloway | (229) 435-6116 | Email hidden; Javascript is required. | Payment Sent | 06/23/2026 | 06/23/2026 | RICKY HUIRAS | Replacement or New Appliance | $200.00 | 1 | New Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RX160IN/P | TG.BA-172134 | 06/23/2026 | OOSTERVEEN.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 | OOSTERVEEN HOMES | (229) 349-9000 | 167 PEBBLE RIDGE DR LEESBURG, Georgia 31763 Map It | 167 PEBBLE RIDGE DR LEESBURG, Georgia 31763 Map It | OOSTERVEEN1.pdf | ||||||||||||||||||
| 2025-29840532 | 06/25/2026 | Modern Gas Company, Inc. | Mark Holloway | (229) 435-6116 | Email hidden; Javascript is required. | Payment Sent | 06/18/2026 | 06/18/2026 | MIKE BURLESON | Replacement or New Appliance | $200.00 | 1 | Replacement Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RL75EP | PC.CA-038687 | 06/18/2026 | ADCOX.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 | NEAL & ELAYNE ADCOX | (229) 894-1298 | 106 LAKESIDE DR CORDELE, Georgia 31015 Map It | 106 LAKESIDE DR CORDELE, Georgia 31015 Map It | ADCOX1.pdf | ||||||||||||||||||
| 2025-54858790 | 06/25/2026 | Folger Gas | Heather Marchman | (706) 367-8782 | Email hidden; Javascript is required. | Payment Sent | 06/24/2026 | 06/24/2026 | Owen Dills | New Construction | $50.00 | 1 | Cooktop ($50.00) | KitchenAid | KFDD94855500 | DE5105678 | 06/24/2026 | img20260625_12161422.pdf | $50.00 | Folger Gas | Heather Marchman | 1950 Bill Wright Road Jefferson, Georgia 30549 Map It | Email hidden; Javascript is required. | (706) 367-8782 | Jeremy Collinsworth | (678) 373-2608 | 305 Harmony Gates Drive Commerce, Georgia 30530 Map It | 305 Harmony Gates Drive Commerce, Georgia 30530 Map It | N/A | |||||||||||||||||||
| 2025-14976120 | 06/25/2026 | Conger LP Gas | Charlie Vining | (912) 501-3009 | Email hidden; Javascript is required. | Payment Sent | 06/24/2026 | 06/24/2026 | Charlie Vining | Replacement or New Appliance | $200.00 | 1 | New Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Rinnai | RE180EP | WC.UA-034448 | 06/24/2026 | Justin-Morgan-Rinnai-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 | Justin Morgan | (912) 292-8730 | 500 Tub Lane Axson, Georgia 31624 Map It | 500 Tub Lane Axson, Georgia 31624 Map It | Justin-Morgan-Rinnai-Rebate1.pdf | ||||||||||||||||||
| 2025-46693747 | 06/25/2026 | Modern Gas Company, Inc. | Mark Holloway | (229) 435-6116 | Email hidden; Javascript is required. | Payment Sent | 06/05/2026 | 06/05/2026 | TY BROWN | New Construction | $200.00 | 1 | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RE180IP | TK.UA-156634 | 06/05/2026 | SINGLETARY.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 | SINGLETARY CONSTRUCTION | (229) 343-5425 | 169 BELMONT DR LEESBURG, Georgia 31763 Map It | 169 BELMONT DR LEESBURG, Georgia 31763 Map It | SINGLETARY CONSTRUCTION | |||||||||||||||||||
| 2025-55971130 | 06/25/2026 | Folger Gas | Stacy Mullinax | (706) 632-7606 | Email hidden; Javascript is required. | Payment Sent | 06/23/2026 | 06/23/2026 | Jeff Dillard | New Construction | $50.00 | 1 | Cooktop ($50.00) | Kitchen Aid | KSGB900ES | RE47128325 | 06/23/2026 | img06252026_0022.pdf | $50.00 | Folger Gas | Stacy Mullinax | 4955 Application Hwy Blue Ridge, Georgia 30513 Map It | Email hidden; Javascript is required. | (706) 632-7606 | Craig Lumia | (239) 404-8488 | Email hidden; Javascript is required. | 4794 Europa Drive Naples, Florida 34105 Map It | 186 Logan Dr Mineral Bluff, Georgia 30559 Map It | N/A | ||||||||||||||||||
| 2025-38758178 | 06/25/2026 | Modern Gas Company, Inc. | Mark Holloway | (229) 435-6116 | Email hidden; Javascript is required. | Payment Sent | 06/16/2026 | 06/16/2026 | ROYCE HUNTER | Replacement or New Appliance | $200.00 | 1 | New Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RX199IN/P | WA.BA-000399 | 06/16/2026 | LARGEMAN.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 | RANDY LARGEMAN | (229) 272-6056 | 168 SILVER LEAF DR ALBANYY, Georgia 31721 Map It | 168 SILVER LEAF DR ALBANYY, Georgia 31721 Map It | LARGEMAN1.pdf | ||||||||||||||||||
| 2025-44888389 | 06/25/2026 | Modern Gas Company, Inc. | Mark Holloway | (229) 435-6116 | Email hidden; Javascript is required. | Payment Sent | 06/23/2026 | 06/23/2026 | ROBBIE & ADA LUCKEY | Replacement or New Appliance | $200.00 | 1 | New Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RX199IN/P | WA.BA-000002 | 06/23/2026 | LUCKEY.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 | ROBBIE & ADA LUCKEY | (229) 869-6663 | 5126 FLINT ROAD CAMILLA, Georgia 31730 Map It | 5126 FLINT ROAD CAMILLA, Georgia 31730 Map It | LUCKEY1.pdf | ||||||||||||||||||
| 2025-99932967 | 06/25/2026 | Modern Gas Company, Inc. | Mark Holloway | (229) 435-6116 | Email hidden; Javascript is required. | Payment Sent | 06/23/2026 | 06/23/2026 | RICKY JARRELL | Replacement or New Appliance | $200.00 | 1 | Replacement Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | GE | GP50T08BXR | SA60330L | 06/23/2026 | BRUNSTON.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 | STACEY BRUNSTON | (229) 269-2482 | 3204 EVERGREEN RD DOERUN, Georgia 31744 Map It | 3204 EVERGREEN RD DOERUN, Georgia 31744 Map It | BRUNSTON1.pdf | ||||||||||||||||||
| 2025-39852547 | 06/26/2026 | Conger LP GAS | christina Duncan | (912) 537-8722 | Email hidden; Javascript is required. | Payment Sent | 06/12/2026 | 06/12/2026 | Jonathan Mauldin | New Construction | $200.00 | 1 | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Rinnai | RE180ep | WD.UA-035854 | 06/12/2026 | WARNOCK-.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 | Amanda Warnock | (229) 392-2250 | 2125 Curtis Green Rd Montrose, Georgia 31065 Map It | 2125 Curtis Green Rd Montrose, Georgia 31065 Map It | Amanda Warnock | |||||||||||||||||||
| 2025-27252227 | 06/26/2026 | Conger LP GAS | christina Duncan | (912) 537-8722 | Email hidden; Javascript is required. | Payment Sent | 06/16/2026 | 06/16/2026 | Jonathan Mauldin | New Construction | $200.00 | 1 | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Rinnai | RE180ep | WD.UA-035851 | 06/16/2026 | MIMS.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 | Allen Mims | (912) 537-8722 | 1881 Bell Telephone Rd Hazelhurst, Georgia 31539 Map It | 1881 Bell Telephone Rd Hazelhurst, Georgia 31539 Map It | Mckenzie Builders Greg | |||||||||||||||||||
| 2025-74566606 | 06/26/2026 | Conger LP GAS | christina Duncan | (912) 537-8722 | Email hidden; Javascript is required. | Payment Sent | 05/26/2026 | 05/26/2026 | Jonathan Mauldin | Replacement or New Appliance | $200.00 | 1 | New Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Rinnai | RX130IN | TD.BA-073389 | 05/26/2026 | COURSON.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 | Rocky Courson | (912) 367-4442 | 314 Timblin Rd Baxley, Georgia 31513 Map It | 870 Lynch Rd Baxley, Georgia 31513 Map It | COURSON1.pdf | ||||||||||||||||||
| 2025-12694448 | 06/29/2026 | Conger LP Gas | KAYLEA SMITH | (229) 469-4250 | Email hidden; Javascript is required. | Payment Sent | 06/16/2026 | 06/16/2026 | Cole Truett | Replacement or New Appliance | $400.00 | 2 | Replacement Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Rinnai | RE160eP | WD.UA-038714 | 06/16/2026 | BUILDING-3053_1145_260629083148_001.pdf | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Rinnai | RE160eP | WD.UA-038725 | 06/16/2026 | BUILDING-3053_1145_260629083148_0011.pdf | $400.00 | 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 | Building Valdosta | (229) 740-0978 | Email hidden; Javascript is required. | 231 Northside Drive Valdosta, Georgia 31602 Map It | 3053 Mary Powell Way Hahira, Georgia 31632 Map It | BUILDING-3053_1145_260629083148_0012.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 |
