Indigenous communities conservation program

Application number
Important

• All Upgrades must be installed by a licensed contractor with a valid BC business license for the trade applicable to the installation work.

• Applications may take up to 90 days to process from the date the completed application package is received. A site visit may be required to verify application details and eligibility before your rebate is paid. If selected for a site visit, you will be contacted by a program representative to schedule a visit.
Instructions

• Carefully read Program Terms and Conditions for full details, requirements and conditions. All capitalized terms that are used, but not defined, in this document have the meaning given to them in the Program Terms and Conditions.

• Applications, together with all required supporting documentation, must be received within 6 months of the invoice date of each eligible Upgrade.

• Invoices or receipts are required for all upgrades. Invoices must be legible, itemized and include: contractor’s company name and address, contractor’s contact information, contractor GST No., invoice number, invoice date, address, make and model number of all items purchased and installed, total cost (including labour), and proof of payment or payment plan (e.g. PAID stamp). Additional Upgrade-specific invoice requirements are outlined in the Terms and Conditions.

• Note: For FortisBC natural gas upgrades, your installation contractor may also be eligible for an incentive from FortisBC, which will be issued to the contractor directly from FortisBC.
Community information
Community name
(The rebate cheque will be issued/payable to the Community name entered here)
Community representative's name Community representative's name First Last
Email
Primary phone number Primary phone number - ### - ### ####
Alternate phone number Alternate phone number - ### - ### ####
Mailing address
(Rebate cheque will be mailed to this address) Mailing address
(Rebate cheque will be mailed to this address)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Additional Community information
Number of participating homes
Contractor Information
Contractor 1
Contractor's business name
Contact person's name Contact person's name First Last
Email
Phone Phone - ### - ### ####
Next contractor
Contractor 2
Contractor business name
Contact person name Contact person name First Last
Email
Phone Phone - ### - ### ####
Next contractor
Contractor 3
Contractor business name
Contact person name Contact person name First Last
Email
Phone Phone - ### - ### ####
Next contractor
Contractor 4
Contractor business name
Contact person name Contact person name First Last
Email
Phone Phone - ### - ### ####
Next contractor
Contractor 5
Contractor business name
Contact person name Contact person name First Last
Email
Phone Phone - ### - ### ####
Next contractor
Contractor 6
Contractor business name
Contact person name Contact person name First Last
Email
Phone Phone - ### - ### ####
Next contractor
Contractor 7
Contractor business name
Contact person name Contact person name First Last
Email
Phone Phone - ### - ### ####
Declaration and consent

• I accept and agree to the Indigenous Communities Conservation Program (the “Program”) Terms and Conditions.

• The information I have provided is true and correct and the product(s) and/or services for which I am requesting a rebate meet the requirements listed on this application form and the Program Terms and Conditions.

• If I am using an Energy Advisor to assist me, I confirm FortisBC may accept information and documents from, deal with, and rely on, the Energy Advisor in the same manner as if they were dealing with me directly, and FortisBC may contact either me or the Energy Advisor to administer, verify compliance with, and evaluate the Program. I further consent to FortisBC communicating with and collecting information about me related to my participation in the Program from the Energy Advisor or the service organizations they represent, and authorize the Energy Advisor and the service organization to disclose such information to FortisBC upon their request.

• FortisBC collects, uses, and discloses personal information in accordance with the following:

FortisBC collects your personal information under the Personal Information Protection Act and FortisBC’s Privacy Policy. For more information, contact Chief Privacy Officer at privacyofficer@fortisbc.com or Suite 100, 1975 Springfield Road, Kelowna, British Columbia, V1Y 7V7
Emails from FortisBC

Emails from FortisBC I agree to receive emails from FortisBC containing news, updates and promotions regarding FortisBC’s products, services, programs and any associated business opportunities.
You may withdraw your consent to receive such emails from FortisBC at any time. Please refer to our Privacy Policy or contact us for more information.
Community representative's name Community representative's name First Last
Date Date / MM / DD YYYY
Community representative's signature

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.

Indigenous communities conservation program

Indigenous communities conservation program

Important

Instructions

Community information

Additional Community information

Contractor Information

Declaration and consent