Rebate Request Form 2009 Southern Indiana Power Rebate Program

Southern Indiana Power

PH: 812-547-2316 Existing Home
Toll Free: 1-800-323-2316 (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: _________________________________________ Date: ___________________ Water Heater
Replacing a gas/propane water heater
Southern Indiana Power Account #: __________________________________________ Energy Factor must 80 gal. $150 $150
be .90 or higher Installing in a new home
Address: ________________________________________________________________
_______________________________________________________________________
Central Air 14 to 15.9 SEER $200 $200 Replacing an old air conditioner
E-Mail Address: ___________________________________________________________
Conditioner 16 to 16.9 SEER $250 $250 Installing in a new AC in a new home
Home Phone: ________________________ Work Phone: ________________________
Please indicate the type of home you have: 17 SEER or higher $300 $300
New Construction
Replacing an old heat pump
Existing Home All Electric 14 to 15.9 SEER $300 $300
Installing a new one in a new home
Mobile or Modular Home Heat Pump 16 to 16.9 SEER $350 $350 Replacing a natural gas, propane, oil
or wood furnace
17 SEER or higher $400 $400
HVAC Water Heater
Brand: ____________________________________ Brand: ________________________________ Heat Pump 14 to15.9 SEER $300 $300 Installing as a dual fuel system either
replacing an existing air conditioner or
Purchased from: ____________________________ Purchased from: ________________________ Dual Fuel 16 to 16.9 SEER $350 $350 an existing heat pump
Outdoor Unit Model #: _______________________ Unit Model #: __________________________ Application Installing as a dual fuel system in a
17 SEER or higher $400 $400
new home
Outdoor Unit Serial#: ________________________ Unit Serial#:____________________________
To replace an old air conditioner in a
Indoor Unit Model #: ________________________ Installed by: ___________________________
All Electric 14 to 15.9 SEER NA $800 home that has:
Indoor Unit Serial#:__________________________ Date Installed:__________________________ electric furnace
Heat Pump 16 to 16.9 SEER NA $900
Installed by: _______________________________ Size (gallons): __________________________ electric ceiling cable heat
(Replace AC) 17 SEER or higher NA $1000 baseboard electric heat
Date Installed:______________________________
other type of wall electric heaters
Size (tons or Btus): __________________________ Building Contractor’s Name: (Total heating needs of the home are being
ARI SEER Rating: ____________________________ ________________________________ met by electric resistance heating units.)

Building Contractor’s Name: __________________ Geothermal $1000 $1000 Installing a new one in a new home
Heat Pump Installing in an existing home
Back-up electric heat Kw: _____________________
ETS Room Unit $30/kw $30/kw
Primary reason for choosing electric HVAC: Primary reason for choosing electric water heater: Installing a new one in a new home
ETS Whole House Unit $300 $300
Lower cost to install Lower cost to install Replacing a gas system
$350 $350
Safety Safety $400 $400
Rebate or Incentive Rebate or Incentive To receive a rebate from Southern Indiana Power, all homeowners must provide ARI (Air conditioning and
Refrigeration Institute) validation for all SEER ratings that can be obtained from the installing heating and For Southern Indiana
Other:__________________________________ Other:______________________________
Power
ALL homeowners must complete a rebate request form and provide proof of purchase to receive any 2009 Use Only:
Age of replaced unit/system: Age of replaced unit/system: Southern Indiana Power rebate. Deadline to apply for 2009 Rebate Program is Dec. 31, 2009. ALL homeowners
and future homeowners receiving Southern Indiana Power rebates agree to the future installation of load
1 to 5 years 1 to 5 years control devices on these rebated appliances to allow Southern Indiana Power the opportunity to engage in Total Rebate Amount:
6 to 10 years 6 to 10 years future demand management load control procedures.
11 to 15 years 11 to 15 years Please sign here to indicate you understand these conditions:
$ ________________
16 or more years 16 or more years
_________________________________________Date:_____________