Heat Pump Water Heater Rebate 2017 ENERGY STAR Residential Water Heater 2 Member InformationName * 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 Electric Account Number * RequiredWhere equipment was installedExisting heating system fuel type * Required Oil Propane Electric Other New Construction What is the heating system fuel type? * RequiredExisting domestic water heating system fuel type * Required Oil Propane Electric Other New Construction Domestic water heating fuel type Other * RequiredContractor 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 Water HeaterEquipmentEFInstall Date - must be mm/dd/yyyy format Tank Size (#Gallons)Manufacturer/BrandModel NumberQuantityRebateSee via instructions aboveTotal CostHome Heat Index Number * RequiredApplicants are required to complete a Home Heating Index (HHI) from the Home Performance w/ Energy Star Program (Does not apply to new construction): http://hhi.nhsaves.com/homeheating/Default.aspxDate Invoices with equipment specs * Required Drop files here or Accepted file types: jpg, png, pdf, doc, docx. Allowed file extensions - jpg png pdf doc docx. Recent Electric Bill * Required File uploadAccepted file types: jpg, png, pdf, doc, docx.Allowed file extensions - jpg png pdf doc docx. Verify & SignDownload 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 Digital Signature * RequiredCAPTCHADate - must be mm/dd/yyyy format