To claim your $100 Furnace Conversion rebate, just send a copy of your paid, dated contractor invoice and this completed form to NIPSCO within 60 days of invoice date. No claim can be processed without a paid invoice copy.

NIPSCO Account Number (see your NIPSCO bill)

Customer

Service Address

City, State, ZIP

Phone

Mailing Address (if different)

City, State, ZIP

Phone

Date of conversion or installation of new equipment:

Equipment Make and Model Number (Furnace) - Rebate: $100

Contractor Company Name

Contractor Phone

This certifies that the above-described work has been completed at my residence, and my furnace has been converted or changed from an energy source not provided by NIPSCO to NIPSCO-provided natural gas.

Homeowner Signature

Date

Print and mail the form along with a copy of your paid, dated contractor invoice within 60 days of the invoice date to:

NIPSCO Consumer Marketing Gas Conversion Program
801 E. 86th Ave.
Merrillville, IN 46410

Be sure to keep a copy of the form for your records. NIPSCO reserves the right to discontinue any program offer at any time without any prior notice. Rebates and other programs are available only to NIPSCO customers.