Residential Electric Water Heaters
(For High-Efficiency Electric Water Heaters Not Purchased from Midland Power)
Click Here for Printable Mail-In Form
Member Information
Application Type
Please select...
Residence Only
Residence/Farm
Residence/Business
Farm Only
Business Only
Commercial/Industry
Apart.Bldg/Unit
Enter your Account #
First Name
Last Name
Street
City
State
Email
Phone
Zip Code
Equipment Location Data
First Name
Last Name
Street
City
State
Zip Code
Hidden fields
Application ID
Salesforce Account
Service Location
Record Type ID
Billing Account Lookup
Salesforce Contact
Page 2
Spec Building
Check if you are a builder/developer and building is not yet owned by live-in residents
Rebate not to exceed 100% of purchase price
Installation and Equipment Information
DATE INSTALLED
Product Type
Integrated Heat Pump Water Heater
Resistance Storage Water Heater
WATER HEATER TYPE REPLACED:
New Construction
Replaces LP Gas
Replaces Electric
Replaces Natural Gas
Other
Home Heating/Cooling Type
Electric heat (ex. air source, geothermal)
Non-electric (central a/c unit)
Installer
Installer Type
Owner
Contractor
Business
(installing contractor)
Address
City
State
Zip
Water Heater Information
Gallon Size
Brand Name
Model Number
Serial Number
ENERGY FACTOR
INSTALLED COST
AGE OF SYSTEM REPL. (yr)
Members must apply for rebates within six (6) months of the purchase date (as shown on the Member's invoice).
ATTACH COPY OF EQUIPMENT PROOF OF PURCHASE
Terms and Conditions
Accept Terms and Conditions
Contact Information