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2. Review requirements and information at
   Attic Air Sealing Rebate

   Charlottesville Gas offers a rebate of up to $150 when you have a licensed contractor perform attic air sealing. * Must meet requirements to qualify for the rebate.

   
   

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. Square Footage covered
26. A copy of your purchase receipt and/or invoice for installation must accompany this form.*

    Copy of the invoice with an itemized cost of the attic air sealing performed.

28. 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 perform air sealing on my home’s attic after April 14, 2025
    5. I have performed attic air sealing on my Charlottesville Gas heated home

    You must check ALL boxes to be considered eligible for this rebate. NOTE: This rebate is available to existing single family homes only; and does not apply to garages or new construction

30. Name*
    Electronic Signature- By adding your name here you agree that everything above is correct and submitted by you.
31. Today's Date*
    Today's Date
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit Submit and Print

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