Heat Pump Water Heater Incentive Application

Comments

This field is for validation purposes and should be left unchanged.

Name*

First Last

Installation Address*

Street Address Address Line 2 City ZIP Code

Mailing Address*

Same as installation address

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Residence Type*

Existing Water Heater Type (must be electric for existing homes)*

Electric

Gas

New Construction

Number of Heat Pump Water Heaters Installed*

Size of Existing Electric Water Heater(s) (Gallons)*

Date of Installation (MM/DD/YYYY)*

Brand Installed*

Model(s) Installed*

Size(s) Installed (gallons)*

Please enter a number from 25 to 200.

Total installed cost before rebates*

Please enter a number from 0 to 10000.

Installation Location*

If other location was selected please enter where the new tank was installed.*

Receipt and Picture Upload*

Please upload a copy of your receipt or invoice showing the brand, model number, size, purchase date and price of the qualifying heat pump water heater. Please also include a picture of the condensate line, the nameplate on the tank and an overview picture of the tank.

Drop files here or

Accepted file types: jpg, gif, pdf, png, jpeg, Max. file size: 100 MB.

Would You Like Your Rebate Applied as a Bill Credit?*

Yes

Installation Checklist

Follow the manufacturer's installation instructions exactly. Failure to do so will result in disqualification from the program, may void the manufacturer's warranty and may result in lower than expected energy savings.

I certify that the following installation items are complete and accurate:*

Water heater was installed according to manufacturer's requirements, and if located in an unconditioned part of the home the water lines are insulated.

Condensate line drains at a slope to a drain or exterior location.

Electronic Member Signature

Rebate amounts and program requirements are subject to change or be discontinued at any time by Central Electric Cooperative (CEC). CEC disclaims any warranty, whether expressed or implied, regarding the equipment listed above and for materials or labor associated with installation, maintenance, repair, or any energy savings associated with use. All locations and jobs are subject to inspection. Electricity usage, job information and all application data may be analyzed or shared to partnering third parties by participating in energy efficiency programs by CEC. Equipment and installation of the job must meet all program criteria to qualify for rebates. I understand the above and certify that the job is completed and operating at the location indicated.

By checking this box and typing my name, I certify that all information on this form is true and correct. I also agree that the checkbox and my name typed below are to be used as my electronic signature. I understand that I can be held liable if I provide false or misleading information.

I certify the above information is true and correct and I am the person submitting this form.

Type Full Name*

Number