ENERGY STAR Certified Residential Water Heater Rebate Member InformationElectric Account Number* Where equipment was installedName* 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 Is this the customer's mailing address?* Yes No Mailing 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 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* Oil Propane Electric Other New Construction Section BreakContractor InformationContractor Name* Phone*Company 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 FaxEmail ENERGY STAR Certified Water HeaterHeat Pump Hot Water Heater Model Number* Heat Pump Water Heater Size (Gallons)* Heat Pump Water Heater Efficiency (>2.3)* Install Date* MM slash DD slash YYYY Quantity*Rebate*Total Cost*Heating 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/Brand Model Number Quantity Rebate Please attach copies of dated invoices with equipment specifications* Drop files here or Select files Accepted file types: pdf, doc, rtf, txt, docx, jpg, png, , Max. file size: 1 GB. 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* 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* MM slash DD slash YYYY Digital Signature* CAPTCHADate MM slash DD slash YYYY Δ