Rebate Submission
Record Type Name
Applicant Information
Enter your Account Number
First Name on Your Account
Last Name
on Your Account
Email
Phone
Service Address Information
Street
City
State Abbreviation
Please select...
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code
Is mailing address different than service address?
Please select...
Yes
No
Mailing Address
Street
City
State Abbreviation
Please select...
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code
Rebate Details
How did you hear about our rebate program?
Please select...
Texas Co-op Power Magazine
Medina EC Website
Social Media
HVAC Technician
Appliance Store
Web Search
Other
Please specify:
Select your rebate request(s)
Water Heater Blanket | $10 Rebate (Must have a value greater than $20, excluding tax)
Electronic Programmable Thermostat | $25 (Must have value greater than $40, excluding tax)
Energy Star Refrigerator | $50 (Must be larger than 10 cu. ft.)
Energy Star Dishwasher | $35
Energy Star Freezer | $35 (Must be larger than 10 cu. ft.)
Energy Star Clothes Washer | $35
Energy Star AC Window Unit | $35
HVAC Tune-up | $60 (Must include service date, contractor's name and phone number. Services must be performed by a qualified licensed service professional.)
Heat Pump Replacement | $400 (Installation must be completed by a qualified licensed service professional. Copy of contractor's original invoice with the model and serial numbers of all equipment installed, and AHRI sheet must be attached.)
Central AC Replacement | $200 (Installation must be completed by a qualified licensed service professional. Copy of contractor's original invoice with the model and serial numbers of all equipment installed, and AHRI sheet must be attached.)
HVAC Tune-up Details
Qualified Licensed Service Professional Acknowledgement
Yes, I acknowledge that the services were performed by a
qualified licensed service professional.
Contractor's Name
Contractor's Company
Contractor's Email
Contractor's Phone
Heat Pump Replacement Details
Qualified Licensed Service Professional Acknowledgement
Yes, I acknowledge that the installation was performed by a qualified licensed service professional.
Installer's Name
Installer's/
Contractor's Company Name
Installer's
Email
Installer's
Phone
Is the service address the same as the installation address?
Please select...
Yes
No
Installation
Address (
Street, City, State Zip)
Central AC Replacement Details
Qualified Licensed Service Professional Acknowledgement
Yes, I acknowledge that the installation was performed by a qualified licensed service professional.
Installer's Name
Installer's/
Contractor's Company Name
Installer's
Email
Installer's
Phone
Is the service address the same as the installation address?
Please select...
Yes
No
Installation
Address (
Street, City, State Zip)
Supporting Documentation
Allowed types:
gif, jpg, png, bmp, eps, tif, pict, psd, txt, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, svg.
Receipts or Contractor Invoice
YOU MUST INCLUDE A RECEIPT OR INVOICE. For replacements: Copy of contractor's original invoice with the model and serial numbers of all equipment installed, and AHRI sheet must be attached. One file only. 20 MB limit.
Heat Pump AHRI Sheet
Energy Star Guide MUST BE included for Refrigerator, Freezer, Dishwasher, Clothes Washer, AC Window Unit. One file only. 20 MB limit.
Central AC AHRI Sheet
Energy Star Guide MUST BE included for Refrigerator, Freezer, Dishwasher, Clothes Washer, AC Window Unit. One file only. 20 MB limit.
Refrigerator Energy Star Energy Guide
Energy Star Guide MUST BE included for Refrigerator, Freezer, Dishwasher, Clothes Washer, AC Window Unit. One file only. 20 MB limit.
Freezer
Energy Star Energy Guide
Energy Star Guide MUST BE included for Refrigerator, Freezer, Dishwasher, Clothes Washer, AC Window Unit. One file only. 20 MB limit.
Dishwasher
Energy Star Energy Guide
Energy Star Guide MUST BE included for Refrigerator, Freezer, Dishwasher, Clothes Washer, AC Window Unit. One file only. 20 MB limit.
Clothes Washer
Energy Star Energy Guide
Energy Star Guide MUST BE included for Refrigerator, Freezer, Dishwasher, Clothes Washer, AC Window Unit. One file only. 20 MB limit.
AC Window Unit
Energy Star Energy Guide
Energy Star Guide MUST BE included for Refrigerator, Freezer, Dishwasher, Clothes Washer, AC Window Unit. One file only. 20 MB limit.
Additional Supporting Documentation (Optional)
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