Massachusetts Clean Energy Center

MassCEC expects to pay the installation rebate within 45 days of receipt of a signed, complete Project Completion Form and all required backup documentation (and the completion of a post-installation audit, if required). The deadline for submission of this form is 30 days after the project is complete. Please note any changes to System Owner information or system details on the Change Request Form. MassCEC reserves the right to inspect or audit any system before or after remittance of the rebate payment.

Project Information

Application Number (as specified on award letter):

Date in Service:

Building Permit #:

Licensed Plumber #:

PAYMENT INFO

System Owner System Owner's Company/Organization Installer

First Name ( Remit to name on check):
Last name

Company name

Address

City:
State:
Zip
Phone

Email:

BackUp Documentation - REQUIRED

Please upload the following required pieces of backup documentation:

Allowed file types are Images(jpg, jpeg, gif, png), PDF, MS-Word and MS-Excel

Copies of Invoices and Payments (Including documentation that OG-100 or OG-300-Certified System was installed and should indicate
equipment changes if applicable). If applying for the additional rebate for Massachusetts-Manufactured Components, invoices must
document equipment from a manufacturer on the list of approved manufacturers:

Photos of Installed System (Collector, Plumbing and Metering) :

W-9
I have sent a completed W-9 Form to Finance@Masscec.Com ( Click here for Instructions and Blank Form)

Building Permit :

Evidence of Plumbing Inspection (if not noted on Building Permit) :

I, the installer, hereby represent that the system meets all requirements as set forth in the Commonwealth Solar Hot Water
Application, Application Instructions, and Terms and Conditions (collectively, the "Application Materials").

Change Request Form (Only to be filled out if any information has changed since the time of application.)

Commonwealth Solar Hot Water Change Request Form - If Applicable

SYSTEM OWNER

First name
Last name

Company name (If Applicable)

Address

City:
State:
Zip
Phone

Email:

Number of Units Served
Number of Occupants Residing in Units Served by System

COLLECTOR

TOTAL SYSTEM SIZE
(Gross Sq Ft Of Collectors) NUMBER OF COLLECTORS SRCC RATING SRCC Collector Performance
(kBTU/panel) Category C Mildly

OG-300 SRCC# :
OG-100 SRCC# :

To find the rating of your collector,
go to www.solar-rating.org
and click on "Certified Collectors
and Ratings".

COLLECTOR (MAKE) COLLECTOR (MODEL)

COLLECTOR TYPE

RACKING TYPE

Please select at least one

Flat Plate Evacuated Tube

Please select at least one

Roof Mount Ground Mount

COLLECTOR AZIMUTH COLLECTOR TILT ANGLE %SHADING

SYSTEM TYPE

Pressurized Drainback

OTHER COMPONENTS

SOLAR STORAGE TANK (MAKE) SOLAR STORAGE TANK (MODEL) SOLAR STORAGE TANK (GALLONS)

CONTROLLER (MAKE) CONTROLLER (MODEL) PUMP (MAKE) PUMP (MODEL)

Additional Notes:

Disclaimer: Under no circumstances will MassCEC provide an adjusted rebate that is more than the originally approved rebate. Notwithstanding the foregoing, MassCEC reserves the right, at its sole discretion, to rescind the rebate or adjust the rebate amount in a manner proportionate to the changes from the approved Application.