CUSTOMER NAME AND MAILING ADDRESS INFORMATION

Primary Customer Contact Name First Name Last Name Secondary Customer Contact Name First Name (optional) Last Name (optional) Mailing Address Mailing Address City, state, zip ,      Is there electrical service at the installation site? Yes No APS Account Number Meter Number Account and meter number must be provided prior to inspection. Installation Address (If same as mailing address, check here ) Installation Address City, state, zip ,

INCENTIVE REQUEST Available residential incentive is a one-time payment of $3.00/Watts DC STC. Incentive payments for system expansions are capped at 50 percent of total cost. Incentive payments for dealers or manufacturers of PV systems and employees of dealers or manufacturers of PV systems are capped at 50 percent of the system cost basis.   Reservation Calculation: $ /Watt x = $     Incentive Level                  DC Watts STC              Total Incentive

EQUIPMENT DEALER INFORMATION   Dealer Name (full legal name) Contact Name Telephone - - Fax Number (optional) - - Mailing Address E-mail Address (optional)

INSTALLER INFORMATION (If same as equipment dealer, check here )

Installer Name (full legal name) Contact Name Telephone - - Fax Number (optional) - - Mailing Address E-mail Address (optional)

Installer's Arizona Registrar of Contractors (AZROC) License Information   Number Class Expiration (MM/DD/YYYY)

How did you hear about the APS Solar Partners Incentive Program? Brochure at Event Annual Use Letter Print Ad TV Web site Radio Other

CUSTOMER CONTACT INFORMATION   Home Phone - - Business Phone - - Cell Phone (optional) - - E-mail Address (optional)

NET BILLING AND NET METERING RATES Please indicate your rate plan choice for compensation received from APS for the power generated by your PV System that will be delivered to the APS distribution system.   EPR-2 (Energy sent back to the APS grid will be purchased by APS at wholesale price, often called “net billing.”) EPR-5 (Energy sent back to the APS grid will appear as a kWh credit on your bill, often called “net metering.”) Rate schedules are posted at www.aps.com or call (602) 328-1924.

ACCESS INFORMATION   Is your electric meter located behind a fence or gate? Yes No If yes, do you have or plan to have a dog at this location? Yes No MISCELLANEOUS INFORMATION   Are you a manufacturer, dealer or installer of PV Systems, or an employee? Yes No Will Customer own the PV system? Yes No If no, please complete 3rd Party Ownership Rider. Are you a developer? Yes No If yes, please complete Developer Rider. Are you the primary occupant at the site location? Yes No If no, are you a landlord or owner? Yes No If yes, please complete Landlord/Tenant Rider. Will payment be assigned to an installer, dealer or manufacturer of the qualifying solar system? Yes No Is this a system expansion? Yes No

PLEASE ATTACH A PROPOSAL FROM YOUR INSTALLER PROVIDING ITEMIZED TOTAL COST FOR YOUR PV SYSTEM INCLUDING INSTALLATION COSTS AND THE INVERTER AND MODULE MODEL AND MANUFACTURER.

NOTE THAT ANY MATERIAL CHANGES TO THE INFORMATION PROVIDED IN THE RESERVATION APPLICATION MUST BE PROVIDED TO APS THROUGH AN AMENDED INCENTIVE AGREEMENT. FAILURE TO SUBMIT AN AMENDED INCENTIVE AGREEMENT AS REQUIRED MAY JEOPARDIZE CUSTOMER’S ELIGIBILITY TO RECEIVE THE INCENTIVE PAYMENT FROM APS.

Please submit by mail to the address listed below:

APS Solar Partners® Incentive Program
P.O. Box 53933, MS 3161
Phoenix, AZ 85072-3933
(602) 328-1924

Customer Name (please type)			APS Representative (please type)
Signature	_____________________________		Signature	_____________________________
Date			Date
Rev. 10/07