Customer Enrollment Form

Please complete the following information to the best of your ability and review and accept the program terms and conditions prior to submitting.

Required fields are designated with a * and will be highlighted in yellow if not filled in.

Business Name

*Primary Contact

Title

*Telephone with Area Code

*Email

I am a San Diego Gas & Electric customer.  Yes No

Account Number:

Business Address (where service is to be performed)

Street

City

Zip Code:

Type of Business

Age of Building

HVAC Contractor

Contact :Name

HVAC Contractor Telephone

HVAC Contractor Email

Number of HVAC units on rooftop

Approx. Tons of Cooling:  --select one-- Less than 5 tons 5-10 tons 11-19 tons 20-39 tons 40-99 tons 100-199 tons 200 tons or more Don't Know

Comments

Program Terms and Conditions

The Premium Efficiency Cooling Program is funded by California utility customers and administered by San Diego Gas & Electric Company® (SDG&E®) under the auspices of the California Public Utilities Commission, through a contract awarded to Conservation Services Group. California customers who choose to participate in this program are not obligated to purchase any additional services offered by the contractor. The trademarks used herein are the property of their respective owners.

Neither the Program, its sponsors, affiliates, nor administrators or officers of the utility are liable for workmanship, damages, or issues arising from contractor performance or non-performance of program services. Participating HVAC contractors are NOT subcontractors to the Program or to the utility. Customers must exercise care and diligence in selecting any HVAC contractor. This program requires that customers allow reasonable access to the site for inspection of services performed. For a list of participating contractors, see www.premiumcooling.com . Program ends 12/31/2012 or when funds are no longer available. Redemption requires valid voucher activation number.

  I understand and accept the terms and conditions of the Program and designate payment of program funds for Premium Tune-up Services to the above designated contractor.

Print Your Name:

By checking this box, I certify that I am the person named above.