Heat Pump Water Heater Rebate

Member Information

Name *

First Last

Address *

Street Address Address Line 2 City State ZIP Code

Is this the customer's mailing address? *

Yes
No

Mailing Address *

Street Address Address Line 2 City State ZIP Code

Phone *

Email *

How did you hear about this rebate?

Electric Account Number *

Where equipment was installed

Existing heating system fuel type *

Oil
Propane
Electric
Other
New Construction

What is the heating system fuel type? *

Existing domestic water heating system fuel type *

Oil
Propane
Electric
Other
New Construction

Domestic water heating fuel type Other *

Contractor Information

Contractor Name *

Phone *

Company Address *

Street Address Address Line 2 City State ZIP Code

Fax

Email

ENERGY STAR Water Heater

Equipment *

EF *

Install Date *

Tank Size (#Gallons) *

Manufacturer/Brand *

Model Number *

Quantity *

Rebate *

See via instructions above

Total Cost *

Home Heat Index Number

Applicants are encouraged 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.aspx

Date Invoices with equipment specs *

Drop files here or

Verify & Sign

Download Eligible Equipment & Incentives, and read Terms and Conditions

I understand the Terms and Conditions *

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 application

Heat Pump Water Heater Rebate

ENERGY STAR Residential Water Heater Rebate

Member Information

Contractor Information

ENERGY STAR Water Heater

Verify & Sign