| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 2025-10803414 | 08/27/2026 | Modern Gas Company, Inc. | Mark Holloway | (229) 435-6116 | Email hidden; Javascript is required. | Payment Sent | 08/20/2026 | 08/20/2026 | TY BROWN | New Construction | $200.00 | 1 | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RE180IP | TM.UA-175215 | 08/20/2026 | SOUTHLAND.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 | SOUTHLAND DEVELOPMENT | (229) 347-8727 | 231 LELAND FERRELL DR LEESBURG, Georgia 31763 Map It | 231 LELAND FERRELL DR LEESBURG, Georgia 31763 Map It | SOUTHLAND DEVELOPMENT | |||||||||||||||||||
| 2025-57984623 | 08/27/2026 | Modern Gas Company, Inc. | Mark Holloway | (229) 435-6116 | Email hidden; Javascript is required. | Payment Sent | 08/20/2026 | 08/20/2026 | ROYCE HUNTER | Replacement or New Appliance | $200.00 | 1 | New Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RX180IN/P | TL.BA-260278 | 08/20/2026 | CHILDS.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 | CHILDS CONSTRUCTION | (229) 759-0206 | 204 FLINTVIEW DR CORDELE, Georgia 31015 Map It | 204 FLINTVIEW DR CORDELE, Georgia 31015 Map It | CHILDS1.pdf | ||||||||||||||||||
| 2025-47304229 | 08/27/2026 | Modern Gas Company, Inc. | Mark Holloway | (229) 435-6116 | Email hidden; Javascript is required. | Payment Sent | 08/21/2026 | 08/21/2026 | curtis hunter | Replacement or New Appliance | $200.00 | 1 | New Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | V53DEP | TG.CA-005251 | 08/21/2026 | SHEFFIELD.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 | JOE SHEFFIELD | (229) 894-2480 | 283 HICKORY GROVE RD LEESBURG, Georgia 31763 Map It | 283 HICKORY GROVE RD LEESBURG, Georgia 31763 Map It | SHEFFIELD1.pdf | ||||||||||||||||||
| 2025-52341826 | 08/27/2026 | Modern Gas Company, Inc. | Mark Holloway | (229) 435-6116 | Email hidden; Javascript is required. | Payment Sent | 08/18/2026 | 08/18/2026 | CURTIS HUNTER | Replacement or New Appliance | $200.00 | 1 | New Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RX180IN/P | TL.BA-260359 | 08/18/2026 | PURVIS.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 | 2017 BEATTIE ROAD ALBANY, Georgia 31721 Map It | 2017 BEATTIE ROAD ALBANY, Georgia 31721 Map It | PURVIS1.pdf | ||||||||||||||||||
| 2025-90748967 | 08/27/2026 | Modern Gas Company, Inc. | Mark Holloway | (229) 435-6116 | Email hidden; Javascript is required. | Payment Sent | 08/21/2026 | 08/21/2026 | RICKY HUIRAS | New Construction | $200.00 | 1 | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RE199EP | TJ.UA-139180 | 08/21/2026 | MOODY.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 | MOODY BROS CONSTRUCTION | (229) 881-1650 | 5749 S TURKEY RD CAMILLA, Georgia 31730 Map It | 5749 S TURKEY RD CAMILLA, Georgia 31730 Map It | MOODY BROS CONSTRUCTION | |||||||||||||||||||
| 2025-96471283 | 08/28/2026 | Conger LP Gas | KAYLEA SMITH | (229) 469-4250 | Email hidden; Javascript is required. | Payment Sent | 08/26/2026 | 08/26/2026 | Joseph Evers | Replacement or New Appliance | $200.00 | 1 | Replacement Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Rinnai | RX160iP | TG.BA-165919 | 08/26/2026 | EVERS_1721_260828085002_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 | Joseph Evers | (229) 244-4372 | Email hidden; Javascript is required. | 7315 Ousley Road Valdosta, Georgia 31601 Map It | 7315 Ousley Road Valdosta, Georgia 31601 Map It | EVERS_1721_260828085002_0011.pdf | |||||||||||||||||
| 2025-45094364 | 08/28/2026 | Folger Gas | Stacy Mullinax | (706) 632-7606 | Email hidden; Javascript is required. | Payment Sent | 08/21/2026 | 08/21/2026 | Jeff Dillard | Replacement or New Appliance | $50.00 | 1 | Conversion | Cooktop ($50.00) | Whrilpool | WSG53330T50 | RF1010687 | 08/21/2026 | img08282026_0014.pdf | $50.00 | Folger Gas | Stacy Miller | 2660 Tennessee 68 Turtletown, Georgia 37391 Map It | Email hidden; Javascript is required. | (706) 455-3537 | Gary Pullias | (941) 773-3321 | Email hidden; Javascript is required. | 57 High Country Lane Morganton, Georgia 30560 Map It | 57 High Country Lane Morganton, Georgia 30560 Map It | img08282026_00141.pdf | |||||||||||||||||
| 2025-59217357 | 08/28/2026 | Folger Gas | Stacy Mullinax | (706) 632-7606 | Email hidden; Javascript is required. | Payment Sent | 08/25/2026 | 08/25/2026 | Fernando Sordo | Replacement or New Appliance | $50.00 | 1 | Conversion | Cooktop ($50.00) | Frigidaire | FCKG3062ASH | VF55162153 | 08/25/2026 | img08282026_0016.pdf | $50.00 | Folger Gas | Stacy Miller | 2660 Tennessee 68 Turtletown, Georgia 37391 Map It | Email hidden; Javascript is required. | (706) 455-3537 | Fannin Co Stn #11 Ems | (706) 455-3934 | Email hidden; Javascript is required. | 400 W Main St. Ste #100 Blue Ridge, Georgia 30513 Map It | 12811 Morganton Hwy Morganton, Georgia 30560 Map It | img08282026_00161.pdf | |||||||||||||||||
| 2025-20019284 | 08/28/2026 | Folger Gas | Stacy Mullinax | (706) 632-7606 | Email hidden; Javascript is required. | Payment Sent | 08/24/2026 | 08/24/2026 | Jeff Dillard | Replacement or New Appliance | $50.00 | 1 | Conversion | Cooktop ($50.00) | GE | PGS930YP9F5 | DD4841119 | 08/24/2026 | img08282026_0017.pdf | $50.00 | Folger Gas | Stacy Miller | 2660 Tennessee 68 Turtletown, Georgia 37391 Map It | Email hidden; Javascript is required. | (706) 455-3537 | Norman Harris | (603) 491-4162 | Email hidden; Javascript is required. | 4190 County Road 12180 Wildwood, Florida 34785 Map It | 142 Arbor Ln Blairsville, Georgia 30512 Map It | img08282026_00171.pdf | |||||||||||||||||
| 2025-45360085 | 08/28/2026 | Folger Gas | Stacy Mullinax | (706) 632-7606 | Email hidden; Javascript is required. | Payment Sent | 08/26/2026 | 08/26/2026 | Dillon Payne | New Construction | $450.00 | 2 | Propane furnace, or gas pack ($400.00) | Lenoxx | CX3443C6F1 | 6013609761 | 08/26/2026 | img08282026_0020.pdf | Cooktop ($50.00) | GE | J6B735SPSS | TR228198P | 08/26/2026 | img08282026_00201.pdf | $450.00 | Folger Gas | Stacy Mullinax | 4955 Appalachian Hwy Blue Ridge, Georgia 30513 Map It | Email hidden; Javascript is required. | (706) 632-7606 | Christina Sayers | (352) 262-6028 | Email hidden; Javascript is required. | 2521 NW 74th Place Gainesville, Georgia 32653 Map It | 84 Shepherd Point Mccaysville, Georgia 30555 Map It | n/a | ||||||||||||
| 2025-77838919 | 08/28/2026 | Folger Gas | Stacy Mullinax | (706) 632-7606 | Email hidden; Javascript is required. | Payment Sent | 08/27/2026 | 08/27/2026 | Brandon Payne | New Construction | $400.00 | 1 | Propane furnace, or gas pack ($400.00) | Bryant | 912SE60080M21 | 3125A57829 | 08/27/2026 | img08282026_0021.pdf | $400.00 | Folger Gas | Stacy Mullinax | 4955 Appalachian Hwy Blue Ridge, Georgia 30513 Map It | Email hidden; Javascript is required. | (706) 632-7606 | Thomas Robinson | (615) 202-5381 | Email hidden; Javascript is required. | 4673 Matthews Road Cedar Hill, Tennessee 37032 Map It | 357 Black Ankle Creek Rd Cherry Log, Georgia 30522 Map It | n/a | ||||||||||||||||||
| 2025-38099066 | 08/28/2026 | Folger Gas | Stacy Mullinax | (706) 632-7606 | Email hidden; Javascript is required. | Payment Sent | 08/26/2026 | 08/26/2026 | Dillon Payne | New Construction | $250.00 | 2 | Cooktop ($50.00) | GE | JGBS66DE4653B | FT200740P | 08/26/2026 | img08282026_0022.pdf | Propane-Fueled Non-Recirculating Water Heater ($200.00) | AW | 60450T40RU01 | 202419667695 | 08/26/2026 | img08282026_00221.pdf | $250.00 | Folger Gas | Stacy Mullinax | 4955 Appalachian Hwy Blue Ridge, Georgia 30513 Map It | Email hidden; Javascript is required. | (706) 632-7606 | Jill Goode | (706) 897-7802 | Email hidden; Javascript is required. | PO Box 1441 Blairsville, Georgia 30512 Map It | 247 Clementine Ln Blairsville, Georgia 30512 Map It | n/a | ||||||||||||
| 2025-21897148 | 08/31/2026 | Webb Brothers Propane, Inc | Kristy Gamble | (229) 382-0789 | Email hidden; Javascript is required. | Payment Sent | 08/28/2026 | 08/28/2026 | ROBERT COTHREN | New Construction | $200.00 | 1 | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RE180EP | WC.UA-025690 | 08/28/2026 | 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 | 142 LAMAR ST OMEGA, Georgia 31774 Map It | OMEGA 786 INC | |||||||||||||||||||
| 2025-71394253 | 08/31/2026 | Folger Gas | Stacy Mullinax | (706) 632-7606 | Email hidden; Javascript is required. | Payment Sent | 08/27/2026 | 08/27/2026 | Jamie Cochran | New Construction | $200.00 | 1 | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Navian | NPE24D52 | 2089Z2613019712 | 08/27/2026 | img08312026_0002.pdf | $200.00 | Folger Gas | Stacy Mullinax | 4955 Appalachian Hwy Blue Ridge, Georgia 30513 Map It | Email hidden; Javascript is required. | (706) 632-7606 | Meghan Beavers | (678) 814-3337 | Email hidden; Javascript is required. | 1061 Eidge Dr. Morganton, Georgia 30560 Map It | 1061 Eidge Dr. Morganton, Georgia 30560 Map It | n/a | ||||||||||||||||||
| 2025-73320177 | 08/31/2026 | Folger Gas | Heather Marchman | (706) 367-8782 | Email hidden; Javascript is required. | Payment Sent | 08/27/2026 | 08/27/2026 | Owen Dills | New Construction | $50.00 | 1 | Cooktop ($50.00) | Monogram | ZGP48611DT2JS | MD904522P | 08/27/2026 | img20260831_09004885.pdf | $50.00 | Folger Gas | Heather Marchman | 1950 Bill Wright Road Jefferson, Georgia 30549 Map It | Email hidden; Javascript is required. | (706) 367-8782 | Luke Jabara | (678) 939-7893 | 665 Sanford Lake Drive Nicholson, Georgia 30565 Map It | 665 Sanford Lake Drive Nicholson, Georgia 30565 Map It | N/A | |||||||||||||||||||
| 2025-13373948 | 08/31/2026 | Folger Gas | Heather Marchman | (706) 367-8782 | Email hidden; Javascript is required. | Payment Sent | 08/27/2026 | 08/27/2026 | Kevin Smoot | New Construction | $250.00 | 2 | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Navien | NPE-240AZ | 2087D25Y2879369 | 08/27/2026 | img20260831_09364613.pdf | Cooktop ($50.00) | THOR | LRG4807 | VLPV02591232 | 08/27/2026 | img20260831_093646131.pdf | $250.00 | Folger Gas | Heather Marchman | 1950 Bill Wright Road Jefferson, Georgia 30549 Map It | Email hidden; Javascript is required. | (706) 367-8782 | John Cown | (706) 202-6348 | 67 Curry Falls Trail Athens, Georgia 30607 Map It | 67 Curry Falls Trail Athens, Georgia 30607 Map It | Les Hoyt Contractors | |||||||||||||
| 2025-72461414 | 08/31/2026 | Conger LP Gas | KAYLEA SMITH | (229) 469-4250 | Email hidden; Javascript is required. | Payment Sent | 08/27/2026 | 08/27/2026 | Matthew Ray | Replacement or New Appliance | $400.00 | 1 | Replacement Installation | Propane-Fueled Recirculating Water Heater ($400.00) | Rinnai | REP160eP | PL.UA-119991 | 08/27/2026 | OWENS-5382_1738_260831125854_001.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 | Owens Vinyl | (229) 482-3375 | Email hidden; Javascript is required. | 14 Murray Blvd Lakeland, Georgia 31635 Map It | 5382 Hamilton Green Circle Valdosta, Georgia 31601 Map It | OWENS-5382_1738_260831125854_0011.pdf | |||||||||||||||||
| 2025-35311407 | 08/31/2026 | Conger LP Gas | KAYLEA SMITH | (229) 469-4250 | Email hidden; Javascript is required. | Payment Sent | 08/27/2026 | 08/27/2026 | Matthew Ray | Replacement or New Appliance | $400.00 | 1 | Replacement Installation | Propane-Fueled Recirculating Water Heater ($400.00) | Rinnai | REP160eP | PL.UA-119934 | 08/27/2026 | OWENS-5354_1739_260831125930_001.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 | Owens Vinyl | (229) 482-3375 | Email hidden; Javascript is required. | 14 Murray Blvd Lakeland, Georgia 31635 Map It | 5354 Hamilton Green Circle Valdosta, Georgia 31601 Map It | OWENS-5354_1739_260831125930_0011.pdf | |||||||||||||||||
| 2025-41463976 | 08/31/2026 | PARTNERS PROPANE OF GA INC. | AMANDA ALBRITTON | (478) 862-4644 | Email hidden; Javascript is required. | Payment Sent | 08/31/2026 | 08/31/2026 | TYLER ROBINSON | Replacement or New Appliance | $200.00 | 1 | Replacement Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RHEEM | PROG40-32P-RH62 | q042631869 | 08/31/2026 | Invoice_20260831_0001.pdf | $200.00 | PARTNERS PROPANE OF GA | AMANDA ALBRITTON | PO BOX 277 BUTLER, Georgia 31006 Map It | Email hidden; Javascript is required. | (478) 862-4644 | JOANNE CHASTAIN | (478) 244-6673 | 470 GARDEN VALLEY RD IDEAL, Georgia 31041 Map It | 470 GARDEN VALLEY RD IDEAL, Georgia 31041 Map It | Invoice_20260831_00011.pdf | ||||||||||||||||||
| 2025-16857550 | 08/31/2026 | Conger LP gas Moultrie | Kyle Johnson | (229) 985-6942 | Email hidden; Javascript is required. | Payment Sent | 08/27/2026 | 08/27/2026 | Taylor Newsome | Replacement or New Appliance | $200.00 | 1 | New Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Rinnai | RE180EP | TL.UA-163717 | 08/27/2026 | 4929_260831151149_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 | Steve Walden | (229) 798-5019 | Email hidden; Javascript is required. | 2380 Sumner Rd Moultrie, Georgia 31768 Map It | 1986 Son Norman Rd Moultrie, Georgia 31768 Map It | 4929_260831151149_0011.pdf | |||||||||||||||||
| 2025-81986754 | 09/01/2026 | Folger Gas | Stacy Mullinax | (706) 632-7606 | Email hidden; Javascript is required. | Payment Sent | 08/28/2026 | 08/28/2026 | Alvin Wilcox | New Construction | $200.00 | 1 | Propane-Fueled Non-Recirculating Water Heater ($200.00) | Rinnai | RX160 | TRBA228812 | 08/28/2026 | img09012026_0005.pdf | $200.00 | Folger Gas | Stacy Mullinax | 4955 Appalachian Hwy Blue Ridge, Georgia 30513 Map It | Email hidden; Javascript is required. | (706) 632-7606 | Jeremy Twiggs DBA Twiggs Construction | (706) 415-5821 | Email hidden; Javascript is required. | PO BOX 915 Blue Ridge, Georgia 30513 Map It | 1107 Brookhaven Ln Mccaysville, Georgia 30555 Map It | Jeremy Twiggs | ||||||||||||||||||
| 2025-89432943 | 09/01/2026 | Folger Gas | Heather Marchman | (706) 367-8782 | Email hidden; Javascript is required. | Payment Sent | 08/26/2026 | 08/26/2026 | Owen Dills | New Construction | $50.00 | 1 | Cooktop ($50.00) | Cafe | C25950P2MSS1 | MD3H050P | 08/26/2026 | img20260901_08525739.pdf | $50.00 | Folger Gas | Heather Marchman | 1950 Bill Wright Road Jefferson, Georgia 30549 Map It | Email hidden; Javascript is required. | (706) 367-8782 | David Bradford | (706) 248-5157 | 251 Tall Timber Trail Nicholson, Georgia 30565 Map It | 251 Tall Timber Trail Nicholson, Georgia 30565 Map It | N/A | |||||||||||||||||||
| 2025-42081433 | 09/01/2026 | Sikes Propane Inc | Daniel Sikes Jr | (912) 367-1151 | Email hidden; Javascript is required. | Payment Sent | 08/21/2026 | 08/21/2026 | DANIEL SIKES | New Construction | $200.00 | 1 | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RE160e | TK.UA-156441 | 08/21/2026 | HPSCAN_20260901152600633_2026-09-01_152648245-compressed.pdf | $200.00 | SIKES PROPANE INC. | SIKES PROPANE | 1488 GOLDEN ISLES WEST BAXLEY, Georgia 31513 Map It | Email hidden; Javascript is required. | (912) 367-1151 | JORDAN ORVIN | (912) 278-5380 | 367 RICARDO STREET BAXLEY, Georgia 31513 Map It | 367 RICARDO STREET BAXLEY, Georgia 31513 Map It | SHANE THORNTON | |||||||||||||||||||
| 2025-78445169 | 09/01/2026 | Partners Propane of Ga Inc | Kim Ogan | (229) 649-4040 | Email hidden; Javascript is required. | Payment Sent | 08/21/2026 | 08/21/2026 | Luke Ogan | Replacement or New Appliance | $200.00 | 1 | Replacement Installation | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RHEEM | PROG40-32P-RH62 | Q322500689 | 08/21/2026 | John-Marlene-Stehman_0001.pdf | $200.00 | PARTNERS PROPANE GA | JAN WHITLEY | 206 W 6TH AVE BUENA VISTA, Georgia 31803 Map It | Email hidden; Javascript is required. | (229) 649-4040 | JOHN & MARLENE STEHMAN | (229) 649-9471 | 165 WESTWIND TRAIL BUENA VISTA, Georgia 31803 Map It | 165 WESTWIND TRAIL BUENA VISTA, Georgia 31803 Map It | John-Marlene-Stehman_00011.pdf | ||||||||||||||||||
| 2025-22201579 | 09/02/2026 | Sikes Propane Inc | Daniel Sikes Jr | (912) 367-1151 | Email hidden; Javascript is required. | Payment Sent | 08/27/2026 | 08/27/2026 | DANIEL SIKES | New Construction | $200.00 | 1 | Propane-Fueled Non-Recirculating Water Heater ($200.00) | RINNAI | RE180e | SE.UA-070300 | 08/27/2026 | HPSCAN_20260901182002999_2026-09-01_182106186-3-compressed.pdf | $200.00 | SIKES PROPANE INC | SIKES PROPANE | 1488 GOLDEN ISLES WEST BAXLEY, Georgia 31513 Map It | Email hidden; Javascript is required. | (912) 367-1151 | BRANTLEY MORRIS | (912) 288-6308 | 96 BRANDON ST BAXLEY, Georgia 31513 Map It | 96 BRANDON ST BAXLEY, Georgia 31513 Map It | SHANE THORNTON | |||||||||||||||||||
| 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 |
