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2. Review requirements and information at
   Attic Insulation Rebate Program

   Charlottesville Gas offers a rebate of up to $300** when you have a licensed contractor add insulation to your home’s attic. * Must meet requirements to qualify for the rebate.

   **Attic Insulation installed between July 1, 2020, and June 30, 2021, is eligible for a $200 rebate only.

4. First Name*
5. Last Name*
7. Service Address*
8. Service Address Zip Code*
10. Mailing Address*
    Put "Same" if your service address is the same as your mailing address.
12. City*
13. State*
14. Zip Code*
16. Phone Number*
17. Gas Account Number
18. Email*
20. Installer's Name*
21. Date of Installation*
    Date of Installation
22. Cost of Installation*
24. Pre-existing R-value prior work being performed
25. Added R- value
27. Square Footage covered
29. Please upload an image of your home's attic with the pre-existing R-value (prior to work being performed)
30. Please upload an image of your home's attic with the new R-value installed (after the work has being performed)
32. A copy of your purchase receipt and/or invoice for installation must accompany this form.*
    A receipt must state pre-existing R-value, added R-value, and square footage covered
34. By checking each box you certify the following: *

    1. I am a Charlottesville Gas customer
    2. My Charlottesville Gas account is in good standing
    3. I use natural gas for home heating
    4. I have had a licensed contractor add insulation to my home’s attic after July 1, 2020
    5. I have installed an upgraded attic insulation on my City gas heated home

    You must check ALL boxes to be considered eligible for this rebate. NOTE: This rebate is not available to new construction.
36. Name*
    Electronic Signature- By adding your name here you agree that everything above is correct and submitted by you.
37. Today's Date*
    Today's Date
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit Submit and Print

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