ENERGY STAR Residential Heat Pump Rebate Energy Star Certified Residential Heat Pump Rebate Member InformationName* 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 Do you have a different mailing address?* Yes No 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 first learn about the heat pump rebates?Advertisement inserted in my billButton up WorkshopContractorEmailFriend/ColleagueInternet search (Google, Bing, Yahoo)NHEC WebsiteNHSavesNewsletterNewspaperPostal mailSocial mediaSelect oneTelephone Town HallOtherElectric Account Number* where equipment was installedExisting heating system fuel type* Oil Propane Electric Other New Construction Is the heat pump replacing existing air conditioning units*YesNoCapacity of the AC system being replaced*in BtU'sContractor InformationBusiness name* Phone*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 Fax NumberEmail Equipment InformationOnly ENERGY STAR® Certified heat pumps meeting the minimum efficiency ratings outlined in the incentives table will be eligible for a rebate. EnergyStar Heat Pump/Mini Split SystemsPlease select your heat pump type Energy Star Certified Central/Hybrid Air Source Heat Pump Geothermal Energy Star Certified Ductless Mini-Split (heat pump) Manufacturer/Brand* Outdoor model number* AHRI Cooling Capacity* Total Cost*Rebate $*Install date* MM slash DD slash YYYY AHRI Ref#* SEER* EER* HSPF* Geothermal COP Heating ControlsEquipment 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, 2022 – December 31, 2022 to be eligible for a rebate.Install date MM slash DD slash YYYY Manufacturer/Brand Model number QuantityTotal costRebate $Please attach copies of dated invoices with equipment make and model specifications.* Drop files here or Select files Accepted file types: pdf, doc, docx, jpg, png, xls, xlsx, Max. file size: 1 GB. Sign HereDownload Eligible Equipment & Incentives, and read Terms and ConditionsI 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* MM slash DD slash YYYY Untitled Δ Energy Star Certified Residential Heat Pump Rebate Member InformationName* 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 Do you have a different mailing address?* Yes No 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 first learn about the heat pump rebates?Advertisement inserted in my billButton up WorkshopContractorEmailFriend/ColleagueInternet search (Google, Bing, Yahoo)NHEC WebsiteNHSavesNewsletterNewspaperPostal mailSocial mediaSelect oneTelephone Town HallOtherElectric Account Number* where equipment was installedExisting heating system fuel type* Oil Propane Electric Other New Construction Is the heat pump replacing existing air conditioning units*YesNoCapacity of the AC system being replaced*in BtU'sContractor InformationBusiness name* Phone*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 Fax NumberEmail Equipment InformationOnly ENERGY STAR® Certified heat pumps meeting the minimum efficiency ratings outlined in the incentives table will be eligible for a rebate. EnergyStar Heat Pump/Mini Split SystemsPlease select your heat pump type Energy Star Certified Central/Hybrid Air Source Heat Pump Geothermal Energy Star Certified Ductless Mini-Split (heat pump) Manufacturer/Brand* Outdoor model number* AHRI Cooling Capacity* Total Cost*Rebate $*Install date* MM slash DD slash YYYY AHRI Ref#* SEER* EER* HSPF* Geothermal COP Heating ControlsEquipment 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, 2022 – December 31, 2022 to be eligible for a rebate.Install date MM slash DD slash YYYY Manufacturer/Brand Model number QuantityTotal costRebate $Please attach copies of dated invoices with equipment make and model specifications.* Drop files here or Select files Accepted file types: pdf, doc, docx, jpg, png, xls, xlsx, Max. file size: 1 GB. Sign HereDownload Eligible Equipment & Incentives, and read Terms and ConditionsI 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* MM slash DD slash YYYY Untitled Δ