ENERGY STAR Residential Heat Pump Rebate Energy Star Certified Residential Heat Pump Rebate Member InformationName* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest 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 AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest 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 AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Fax NumberEmail Equipment InformationOnly 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 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, 2019 – December 31, 2019 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 AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest 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 AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest 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 AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Fax NumberEmail Equipment InformationOnly 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 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, 2019 – December 31, 2019 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