Heat Pump Rebate Application

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Applicant Information

Enter your Account #

First Name (as it appears on your bill)

Last Name (as it appears on your bill)

Phone

How did you hear about our program?

Local Organization Name

Contractor Name

Retailer Name

Service Address Information

Street

City

State Abbreviation

Zip Code

New System Information

To apply for a Heat Pump Rebate, you must submit the following within 90 days of installation:

Completed and signed application
Invoice/Proof of purchase (materials and labor shown separately)

System Type:

Number of Units

Note: Accounts may be eligible for more than one rebate depending on the project scope or building type and will be handled on a case-by-case basis.

Installation Contractor

Date Equipment Installed

Air Source Ducted

Application Record Type ID

System Type Replacing

Energy Star Certified Ducted Heat Pump (manually enter)

Outdoor Brand Name

Series Name

Outdoor Unit Model Number

Indoor Unit Model Number

Furnace Model Number

AHRI Certification Number

Energy Star Website: Click Here

Heating Capacity Calculation (in BTUs)

Cold Climate

Size (total installed Tons)

SEER

HSPF

-or- (if available) SEER 2

-or- (if available) HSPF 2

AHRI Certification Number

Controlled ETS Backup Heat?

Equipment Cost

Air Source Ductless/Mini-Split

Application Record Type ID

System Type Replacing

Energy Star Website: Click Here

Energy Star Certified Ducted Heat Pump (manually enter)

Product Manufacturer

Product Model Number

Brand Name

Series Name

Heat Pump Information

Provide detailed product information

Energy Star Website: Click Here
Lookup your Heat Pump Ducted information from the Energy Star Website

Heating Capacity Calculation (in BTUs)

Cold Climate

Size (total installed Tons)

SEER

HSPF

-or- (if available) SEER 2

-or- (if available) HSPF 2

Controlled ETS Backup Heat?

Equipment Cost

Ground Source

Application Record Type ID

Is desuperheater (domestic hot water) equipment being installed? Adds $100 to rebate incentive

System Type Replacing

Energy Star Website: Click Here

Energy Star Certified Ducted Heat Pump (manually enter)

Product Manufacturer

Product Model Number

Size (total installed Tons)

EER

COP

Controlled ETS Backup Heat?

Equipment Cost

Terminal Unit

Application Record Type ID

System Type Replacing

Note: Accounts may be eligible for more than one rebate depending on the project scope or building type and will be handled on a case-by-case basis.

Energy Star Website: Click Here

Energy Star Certified Ducted Heat Pump (manually enter)

Product Manufacturer

Product Model Number

Size (total installed Tons)

SEER

HSPF

-or- (if available) SEER 2

-or- (if available) HSPF 2

Controlled ETS Backup Heat?

Equipment Cost

Air-to-Water

Application Record Type ID

System Type Replacing

Note: Accounts may be eligible for more than one rebate depending on the project scope or building type and will be handled on a case-by-case basis.

Energy Star Website: Click Here

Energy Star Certified Ducted Heat Pump (manually enter)

Product Manufacturer

Product Model Number

Size (total installed Tons)

Controlled ETS Backup Heat?

Equipment Cost

Attach Invoice Here

Acknowledgement

By checking this box, I understand that I must have an active MVEA electric service account in order to request product rebates. I affirm the information provided is accurate to the best of my knowledge, and is completed in its entirety.

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