Rebate Request Form 2009 Harrison REMC Rebate Program

Harrison REMC
738-4115 or 951-2323 Existing Home
(Including
Type of System New Mobile or
Please provide the necessary information pertaining to your particular request. Rebates cannot be (check all that apply) Specs Homes Modular) Check the conditions that apply
processed without complete information and proof of purchase (invoice or receipt.)
Electric 40, 50 or 75 gal. $50 $50 Replacing old electric water heater
Name: __________________________________________________________________ Water Heater
Replacing a gas/propane water heater
Harrison REMC Account #: __________________________________________________ Energy Factor must 80 gal. $150 $150
be .90 or higher Installing in a new home
Address: ________________________________________________________________
Home Phone: ____________________________________________________________
Central Air 14 to 15.9 SEER $100 $100 Replacing an old air conditioner
Work Phone: _____________________________________________________________
Please indicate the type of home you have: Conditioner 16 to 16.9 SEER $150 $150 Installing in a new AC in a new home.
New Construction 17 SEER or higher $200 $200
Existing Home Replacing an old heat pump
Mobile or Modular Home All Electric 14 to 15.9 SEER $200 $200 Install a new one in a new home
Heat Pump 16 to 16.9 SEER $250 $250 Replacing a natural gas
HVAC Water Heater Replacing propane
17 SEER or higher $300 $300 Replacing oil furnace
Brand: ____________________________________ Brand: ________________________________ Replacing wood furnace
Purchased from: ____________________________ Purchased from: ________________________ In a home addition
Outdoor Unit Model #: _______________________ Unit Model #: __________________________ Installing as a dual fuel system either
Heat Pump 14 to15.9 SEER $200 $200 replacing an existing air conditioner or
Outdoor Unit Serial#: ________________________ Unit Serial#:____________________________ an existing heat pump
16 to 16.9 SEER $250 $250
Indoor Unit Model #: ________________________ Installed by: ___________________________ Dual Fuel
Application Installing as a dual fuel system in a
17 SEER or higher $300 $300 new home
Indoor Unit Serial#:__________________________ Date Installed:__________________________
Installed by: _______________________________ Size (gallons): __________________________
All Electric 14 to 15.9 SEER NA $700 To replace an old air conditioner in a
Date Installed:______________________________ Energy Factor Rating: ____________________
home that has:
Size (tons or Btus): __________________________ Type of home HVAC:_____________________ Heat Pump 16 to 16.9 SEER NA $800 electric furnace
ARI SEER Rating: ____________________________ Building Contractor’s Name: 17 SEER or higher NA $900 electric ceiling cable heat
baseboard electric heat
Building Contractor’s Name: __________________ ________________________________
other type of wall electric heaters
Back-up electric heat Kw: _____________________ (Total heating needs of the home are being
Primary reason for choosing electric water heater: met by electric resistance heating units.)

Primary reason for choosing electric HVAC: Lower cost to install Geothermal $900 $900 Installing in a new construction
Lower cost to install Safety Heat Pump Installing in an existing home
Safety Rebate or Incentive
To receive a rebate from Harrison REMC, all homeowners must provide ARI (Air conditioning and
Rebate or Incentive Other:______________________________ Refrigeration Institute) validation for all SEER ratings. This form can be obtained from the installing heating
Other:__________________________________ and cooling dealer. No rebate will be awarded based on HVAC dealer bid specifications, promotional For Harrison REMC
material of dealer, manufacturer or any other source than ARI. A certificate of ARI-certified performance Use Only:
Age of replaced unit/system: Age of replaced unit/system: must be submitted. ALL homeowners must complete a rebate request form and provide proof of purchase to
1 to 5 years 1 to 5 years receive any 2009 Harrison REMC rebate. Deadline to apply for 2009 Rebate Program is Dec. 1, 2009. ALL Total Rebate Amount:
homeowners and future homeowners receiving Harrison REMC rebates agree to the future installation of
6 to 10 years 6 to 10 years load control devices on these rebated appliances to allow Harrison REMC the opportunity to engage in
future energy management load control procedures.
11 to 15 years 11 to 15 years
$ _________________
16 or more years 16 or more years Please sign here to indicate you understand these conditions:
_______________________________________Date:_______________