"*" indicates required fields PhoneThis field is for validation purposes and should be left unchanged.Homeowner Name* First Last Installation Address* Street Address Address Line 2 City ZIP Code Mailing Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone*Email* Type of Electric Heat*FurnaceHeat PumpZonal (Baseboard, Wall, Plug-in)Year House Was Built*House Type*Site BuiltManufactured HomeDate of Installation* MM slash DD slash YYYY What Weatherization Was Completed?* Windows and Sliding Glass Doors Exterior Doors Insulation Whole Home Air Sealing (Please attach technician's supporting documentation) Existing Window Type* Single Pane Double Pane Metal Frame Double Pane Wood Frame Double Pane Vinyl Frame How Many Windows and Sliding Glass Doors Were Replaced?*How Many Exterior Doors Were Replaced?*Where Was Insulation Updated?* Ceiling Insulation Floor Insulation Wall Insulation Duct Insulation Was Prescriptive Air Sealing Performed?This is air sealing that is done without the verification of a blower door test. The air sealing must meet CEC specifications as found on our website. Air sealing must be listed on the final invoice. Yes No How Many Square Feet of Ceiling Insulation Was Updated?*How Many Linear Feet of Duct Insulation Was Updated?*What Was the existing R-Value of the Ceiling Insulation?*What is the Ending R-Value of the Ceiling Insulation?How Many Square Feet of Floor Insulation Was Updated?*What Was the existing R-Value of the Floor Insulation?*What is the Ending R-Value of the Floor Insulation?How Many Square Feet of Wall Insulation Was Updated?*What Was the existing R-Value of the Wall Insulation?*What is the Ending R-Value of the Wall Insulation?Document Upload*Please upload a copy of documentation showing the size of each window, U-value of each window and door, window or door brand, model information showing, purchase date and price, your receipt or other. For Insulation the documentation must state square footage replaced and the new and existing R-value. Drop files here or Select files Max. file size: 100 MB. Would You Like Your Rebate Applied as a Bill Credit?*Rebate amounts $250 and under are automatically applied as a bill credit. Yes No Installation ChecklistFollow the manufacturer's installation instructions and the CEC Weatherization Program Specifications 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.Electronic Member SignatureRebate 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. Rebates $250 and under will be credited to a member’s bill. Applicant certifies that they are not excluded, disqualified, or debarred from receiving federal assistance and are not on the Federal Suspension and Debarment list.Digital Signature*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*Consent*CEC Privacy Policy I agree to the privacy policy.
Outage Map
