Page 17 - may-june 2021_Neat

Alabama Propane Gas Association

173 Medical Center Drive, Prattville, AL 36066
334-358-9590 • 334-358-9520 FAX

2020-2021 ALABAMA REGULATOR REPLACEMENT REBATE PROGRAM
This program is available on qualified regulators installed on or after October 12, 2020
until September 17, 2021 or funds are depleted, whichever comes first.

Only participating propane marketers may apply. To apply for this rebate, print all required information and document safety
inspection information below or attach a copy of the safety inspection form. Submit application to APGA for approval and payment
and retain a copy for your records. Double-check your application for completeness; errors will disqualify the application.

APPLICANT INFORMATION
Company Name:____________________________________________________________________
Address:______________________________________ City/State/Zip:_________________________

Phone: ( )_________________________ E-mail: _____________________________________

LOCATION OF INSTALLATION
Customer Name:____________________________________________________________________

Address:__________________________________City/State/Zip:______________________________

REGULATOR INFORMATION

NEW: Brand_______________Model #_______________________Install Date:_________________
Date Stamp or Code:________________________________
NEW: Brand_______________Model #_______________________Install Date:_________________
Date Stamp or Code:________________________________
OLD: Brand_______________Model #_______________________
Date Stamp or Code:________________________________
OLD: Brand_______________Model #_______________________
Date Stamp or Code:________________________________

Submit the following information with your application (failure to submit will disqualify application)
( ) Copy of propane company safety inspection
OR
Leak Check
Start Pressure: End Pressure: Time Held:

Regulator Check
Type Flow Pressure Lock-up Pressure

I understand and agree to all the rules and conditions of this program. I affirm that the installation at this
location is eligible for this program and meets all program requirements. I declare that I am authorized to
sign this application and affirm that this installation has passed a safety inspection as certified by the
attached inspection form or the information provided on this application form.
__________________________________________________________________________________
Signature of Company Representative Date

17 Alabama Propane Gas Association | May / June 2021