ENERGY STAR Residential Heat Pump Rebate

Customer Information

Name *

First Last

Address *

Street Address Address Line 2 City State ZIP Code

Do you have a different mailing address? *

Yes
No

Address

Street Address Address Line 2 City State ZIP Code

Phone *

Email *

How did you first learn about the heat pump rebates?

Electric Account Number *

where equipment was installed

Existing heating system fuel type *

Oil
Propane
Electric
Other
New Construction

Please specify

Existing domestic water heating system fuel type *

Oil
Propane
Electric
Other
New Construction

Please specify

Is the heat pump replacing existing air conditioning units *

Capacity of the AC system being replaced *

in BtU's

Contractor Information

Business name *

Phone *

Address *

Street Address Address Line 2 City State ZIP Code

Fax Number

Email

Equipment Information

Only ENERGY STAR® Certified heat pumps and heat pump water heaters meeting the minimum efficiency ratings outlined in the incentives table will be eligible for a rebate.

EnergyStar Heat Pump/Mini Split Systems

Please select a heat pump type

Central/Hybrid Air Source Heat Pump
Geothermal
Ductless Mini-Split (heat pump)

Manufacturer/Brand *

Outdoor model number *

Indoor model number *

Total Cost *

Rebate $ *

Install date *

AHRI Ref# *

SEER *

EER *

HSPF *

Geothermal COP

Heating Controls

Equipment

WI-FI Thermostat (for Heat Pumps Only)**

**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, 2018 – December 31, 2018 to be eligible for a rebate.

Install date

Manufacturer/Brand

Model number

Quantity

Total cost

Rebate $

Please attach copies of dated invoices with equipment make and model specifications. *

Drop files here or

Sign Here

Download Eligible Equipment & Incentives, and read Terms and Conditions

I have read and understand the terms and conditions. I certify that the information I have provided is true and correct and the products(s) and equipment for which I am requesting an incentive meets the requirements in this application. *

Yes

Customer Digital Signature *

Date *