ENERGY STAR Certified Residential Water Heater Rebate ENERGY STAR Certified Residential Water Heater Rebate Member InformationElectric Account Number* Where equipment was installedName* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is this the customer's mailing address?* Yes No Mailing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* How did you hear about this rebate?Select oneAdvertisement inserted in my billButton up workshopContractorEmailInternet search (Google, Bing, Yahoo)Friend/ColleagueNHEC newsletterNHEC representativeNHSavesNewspaperPostal mailSocial media (Facebook, Twitter, LinkedInExisting domestic water heating system fuel type* Oil Propane Electric Other New Construction Section BreakContractor InformationContractor Name* Phone*Company Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code FaxEmail ENERGY STAR Certified Water HeaterHeat Pump Hot Water Heater Model Number* Heat Pump Water Heater Size (Gallons)* Heat Pump Water Heater Efficiency (>2.3)* Install Date* MM slash DD slash YYYY Quantity*Rebate*Total Cost*Heating ControlsWi-Fi Thermostat (for Heat Pumps Only) Yes * Wi-Fi Connections must be enabled. Rebate not to exceed purchase price. Limit one (1) thermostat per heat pump zone installed per account. Qualifying equipment must be installed between January 1, 2019-December 31, 2019 to be eligible.Manufacturer/Brand Model Number Quantity Rebate Please attach copies of dated invoices with equipment specifications* Drop files here or Select files Accepted file types: pdf, doc, rtf, txt, docx, jpg, png, , Max. file size: 1 GB. Verify & SignOnly ENERGY STAR® Certified heat pumps and heat pump water heaters meeting the minimum efficiency ratings outlined in the incentive will be eligible for a rebate.Download Eligible Equipment & Incentives, and read Terms and ConditionsI understand the Terms and Conditions* Yes I have read and understand the terms and conditions of this application. I certify that the information I have provided is true and correct and the product(s) and equipment for which I am requesting an incentive meets the requirements of this applicationDate* MM slash DD slash YYYY Digital Signature* CAPTCHADate MM slash DD slash YYYY Δ