ENERGY STAR Certified Residential Water Heater Rebate Member InformationElectric Account Number * RequiredWhere equipment was installedName * Required First Last Address * Required 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 Is this the customer's mailing address? * RequiredYesNoMailing Address * Required 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 * RequiredEmail * Required 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 * Required Oil Propane Electric Other New Construction Section BreakContractor InformationContractor Name * RequiredPhone * RequiredCompany Address * Required 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 FaxEmail ENERGY STAR Certified Water HeaterHeat Pump Hot Water Heater Model Number * RequiredHeat Pump Water Heater Size (Gallons) * RequiredHeat Pump Water Heater Efficiency (>2.3) * RequiredInstall Date - must be mm/dd/yyyy format * Required Date Format: MM slash DD slash YYYY Quantity * RequiredRebate * RequiredTotal Cost * RequiredHeating 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/BrandModel NumberQuantityRebatePlease attach copies of dated invoices with equipment specifications * Required Drop files here or Accepted file types: pdf, doc, rtf, txt, docx, jpg, png, . 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 * Required 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 - must be mm/dd/yyyy format * Required Date Format: MM slash DD slash YYYY Digital Signature * RequiredCAPTCHADate - must be mm/dd/yyyy format Date Format: MM slash DD slash YYYY