Heat Pump Rebate Form

You must receive service from Poudre Valley REA to be eligible for rebates. Rebate requests must be submitted within 90 days of purchase or installation to qualify. Rebates under $250 are applied as a bill credit. Rebates over $250 are issued to you as a check.

Typically the rebate process takes 4-6 weeks to complete.

All rebates are for new equipment only.

Applicant Information:

First Name

Last Name

PVREA Account Number

Account numbers should be less than 10 digits no special characters

Street

Zip Code

City

State

Consumer Type

Heated Square Footage (SF)

New or Replacement

NewReplacement

Backup

Electric ResistanceNatural GasPropaneControlled ETSRequired only if Air Source

System Type Replacing

Replacement of Existing Air Source Heat PumpReplacement of Other Electric HeatReplacement of Natural Gas HeatReplacement of Propane HeatReplacement of Current Ground Source Heat PumpNew Construction

Controlled ETS Backup Heat?

YesNo

Quantity (No. of Units)

Unit 1

System Type

Ground SourceAir Source DuctedAir Source Ductless/Mini-Split

Ducted System

YesNo

Outdoor Brand Name

Outdoor Unit Model Number

Series Name (Can be found in the AHRI data sheet)

Cold Climate

YesNo

Heating Capacity - Please only type numbers (i.e. 12000)

(12,000 BTUs = 1 ton, 24,000 BTUs = 2 tons, etc...)

SEER

SEER2 (If Available)

HSPF

HSPF2 (If Available)

Indoor Unit Model Number (Can be located in the AHRI data sheet)

Furnace Model Number (Can be found in the AHRI data sheet)

Unit 2

System Type

Ground SourceAir Source DuctedAir Source Ductless/Mini-Split

Ducted System

YesNo

Outdoor Brand Name

Outdoor Unit Model Number

Series Name (Can be found in the AHRI data sheet)

Cold Climate

YesNo

Heating Capacity - Please only type numbers (i.e. 12000)

(12,000 BTUs = 1 ton, 24,000 BTUs = 2 tons, etc...)

SEER

SEER2 (If Available)

HSPF

HSPF2 (If Available)

Indoor Unit Model Number (Can be located in the AHRI data sheet)

Furnace Model Number (Can be found in the AHRI data sheet)

Unit 3

System Type

Ground SourceAir Source DuctedAir Source Ductless/Mini-Split

Ducted System

YesNo

Outdoor Brand Name

Outdoor Unit Model Number

Series Name (Can be found in the AHRI data sheet)

Cold Climate

YesNo

Heating Capacity - Please only type numbers (i.e. 12000)

(12,000 BTUs = 1 ton, 24,000 BTUs = 2 tons, etc...)

SEER

SEER2 (If Available)

HSPF

HSPF2 (If Available)

Indoor Unit Model Number (Can be located in the AHRI data sheet)

Furnace Model Number (Can be found in the AHRI data sheet)

Unit 4

System Type

Ground SourceAir Source DuctedAir Source Ductless/Mini-Split

Ducted System

YesNo

Outdoor Brand Name

Outdoor Unit Model Number

Series Name (Can be found in the AHRI data sheet)

Cold Climate

YesNo

Heating Capacity - Please only type numbers (i.e. 12000)

(12,000 BTUs = 1 ton, 24,000 BTUs = 2 tons, etc...)

SEER

SEER2 (If Available)

HSPF

HSPF2 (If Available)

Indoor Unit Model Number (Can be located in the AHRI data sheet)

Furnace Model Number (Can be found in the AHRI data sheet)

Sizing Calculation Results (BTU)

External Static Pressure (IWC)

Air Flow - Calculated (CFG/Ton)

Air Flow CFM within 15% of Required CFM?

YesNo

Ground Source

Desuperheater Included

YesNoAdditional $100 Rebate

Replacement of Air Handler only

YesNo

COP

EER

Date Equipment Installed

Installer (HVAC Company Name)

Equipment Cost

Comments

Copies of receipt or invoices.

Invoice must include unit cost

Copy of contractor ground loop design

HVAC Contractor's Commissioning Form

Manufacturer's data sheet

If your letter or recommendation need to be send directly, please provide this email address::...

AHRI Certificate

Do you need to attach additional documentation?

YesNo

Additional Attachment 1

Additional Attachment 2

Additional Attachment 3

Additional Attachment 4

Additional Attachment 5

Contact Information