Please contact a programrepresentative for multiplepump systems or multiple

pumps on a single property.

Page 1

TEP or UES Customer Information

ACCOUNT NUMBER

CUSTOMER NAME (AS IT APPEARS ON TEP OR UES BILL)

INSTALLATION ADDRESS APT #

CITY STATE ZIP CODE

MAILING ADDRESS (IF DIFFERENT FROM INSTALLATION) APT #

CITY STATE ZIP CODE

CONTACT NAME (IF DIFFERENT FROM CUSTOMER)

CONTACT PHONE E-MAIL

Property Occupied by: Owner Tenant Building Type: Custom Tract Town Home Duplex

HAVE YOU PARTICIPATED IN THIS PROGRAM IN THE PAST? YES NO

TERMS AND CONDITIONS

CUSTOMER SIGNATURE DATE

NEW PUMP INFORMATION

SALE/PURCHASE DATE

SERIAL NUMBER

INSTALLATION DATE

POOL PUMP PRICE BEFORE REBATE*

*Price excluding rebate and without installation or other costs.

PROGRAM GUIDELINES

Applicant must be a Tucson Electric Power (TEP) or

UniSource Energy Services (UES)residential electric customer.

Pool must be located in TEP’s or UES’ territory.

Pump must be installed on asingle family residential,

in-ground swimming pool.

Pump must be a qualifying newvariable-speed unit (replacement

motors do not qualify).

Rebates are subject toavailability of funds.

Rebate cannot be used whenreplacing a variable-speed pump.

PUMP HORSEPOWER (H.P.)

MANUFACTURER

MODEL NUMBER

RETAILER/POOL PROFESSIONAL/OTHER

STORE ID NUMBER OR LOCATION

FOR PROGRAM QUESTIONS PLEASE CALL: 844-237-2834

The rebate/calibration formmust accompany the invoice

and must be submitted viathe online portal within 45 days

of pump purchase date to beeligible for payment.

Rebates are only availableon quali�ed variable-speed

pumps purchased through anapproved pool professional.

Rebates are not availablefor water features, slides,

standalone spas andbooster pumps.

I certify that I am a Tucson Electric Power (TEP) or UniSource Energy Services (UES) customer, and that the pool pump for which I am applying for a rebate will be installed at the address identified above. I further certify that I have read and understand all program requirements, terms, and conditions, and will comply with TEP and UES program policies. I also agree that the party who installs the pool pump and performs any other services on my property associated with this rebate application is solely responsible for the performance of their work. It is understood and agreed that neither the party from whom I am purchasing the pool pump nor the party installing the pool pump on my property are agents, servants, or employees of TEP and UES. I hereby indemnify and hold harmless TEP and UES, their officers, directors, employees, agents, representatives, affiliates, successors, and assigns from any liability cost, or expense, including reasonable attorney’s fees and legal costs, arising out of or resulting from the pool pump and/or any services related to the pool pump’s installa-tion. I further certify that all information provided herein is accurate to the best of my knowledge, that TEP or UES may verify the accuracy of all information, and that all installations are subject to random inspections by TEP and UES or an authorized representative of TEP and UES. TEP and UES reserve the right to change or terminate the program at any time.

IF YES, PLEASE CALL (844) 237-2834

Variable-Speed Pool Pump Rebate/Calibration Form

Tucson Electric Power and UniSource Energy Services POOL PUMP PROGRAM

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POOL INSTALLATION/CALIBRATION COMPANY CONTACT INFORMATION

NAME OF SALES OR CALIBRATION COMPANY CERTIFIED CALIBRATOR (PRINT FULL NAME)

CITY STATE PHONE #

REPLACING AN EXISTING POOL PUMP? YES NO (IF YES, PLEASE COMPLETE THE INFORMATION BELOW FOR THE OLD PUMP.)

EXISTING/OLD POOL PUMP INFORMATION (CANNOT BE A VARIABLE-SPEED PUMP)

MANUFACTURER

MODEL NUMBER

HORSEPOWER (H.P.)

VARIABLE-SPEED POOL PUMP CALIBRATION INFORMATION

DATE OF CALIBRATION POOL VOLUME (GALLONS)

Type of Cleaning System: In-floor Automatic (Side Suction) None Salt Chlorinator: Yes No

Heating System: Solar Standalone None Automation Systems: Yes No

Settings After Calibration

COMMENT/NOTES

By signing as the Calibration Technician, I certify the calibration of the new variable-speed pump was completed per the program requirements and as documented on this Pool Pump Rebate/Calibration form.

CERTIFIED CALIBRATOR SIGNATURE DATE

SUMMER (HRS/DAY) WINTER (HRS/DAY)

Average daily pool pump run time

NUMBER OF MONTHS IN SUMMER MODE

Rev 7/16

LOW-SPEED SETTING RUN HOURS / DAY RPM WATTS

Filtration

HIGH-SPEED SETTING RUN HOURS / DAY RPM WATTS

Cleaner, solar heater or spa

OPTIONAL RUN CYCLE RUN HOURS / DAY RPM WATTS

Additional runtime setting

TURNOVER RATIO

TURNOVER RATIO

TURNOVER RATIO