Ee Res Equip App

2009 IOWA RESIDENTIAL EQUIPMENT PROGRAM REBATE APPLICATION ATTENTION DEALERS:

P l e a s e c o m p l e te b o t h s i d e s o f t h i s a p p l i c a t i o n a n d a tt a ch c o p i e s o f i nvo i c e s .

Please photocopy this form and save the original for future use or download additional copies at www.midamericanenergy.com/rebates.

Thank you for participating in the Residential Equipment program. After purchasing and installing qualifying equipment, please follow these simple instructions. 1.

Select equipment based on the energy ratings and terms and conditions shown on the Residential Equipment Rebate Schedule. Equipment included in the EnergyAdvantage New Homes program comprehensive incentive is not eligible for additional incentives in the Residential Equipment program. Only approved equipment is eligible for energy efficiency rebates.

2.

Complete this Residential Equipment Rebate Application, including signature.

3.

Attach a dated invoice from your dealer, including manufacturer’s name, model/serial number and quantity of equipment purchased and installed. Equipment must be installed between Jan. 1 – Dec. 31, 2009, and use natural gas or electricity provided directly from MidAmerican.

4.

After equipment is installed and operating, submit the Residential Equipment Rebate Application and invoice to address shown below.

5.

Equipment must be installed in the state of Iowa. Mail to: MidAmerican Energy Company, EnergyAdvantage Programs, P.O. Box 7232, Des Moines, IA 50309-7232 or fax to 515-244-8825. Call 800-894-9599 with questions about the program.

You may have the option of financing this energy-efficient equipment or choosing a cash rebate. To learn more about financing before you proceed, please call us at 800-894-9599. CUSTOMER INFORMATION MidAmerican account number(s) (found on bill) Installation address City

State

ZIP

State

ZIP

Name on account Rebate check (if applicable) should be payable to (name) Mailing address City Phone

E-mail address

CUSTOMER AGREEMENT My signature indicates consent to and agreement with all program terms and conditions; and certifies that all information on this application is correct; and that all of the listed new equipment has been purchased, installed and is operating at the indicated location. I understand that MidAmerican reserves the right to inspect and verify installation before or after issuing the rebate payment. Customer signature

Date

E-mail address

INSTALLING DEALER INFORMATION Dealer name Address City Contact person Fax

State

ZIP Phone E-mail address

DEALER AGREEMENT I certify that all equipment and installation information provided on this application is correct and accurate. Installer/dealer signature Date For MidAmerican Energy Use

HAVE YOU SIGNED THIS FORM?

FAF rebate $________________________ CAC rebate $_______________________

HAS YOUR DEALER SIGNED THIS FORM?

GWH rebate $_______________________ AOHP rebate $______________________

HAVE YOU ENCLOSED A COPY OF YOUR INVOICE?

Boiler rebate $_______________________ ASHP rebate $______________________ APP rebate $_______________________

WAC rebate $_______________________

Fan rebate $_______________________

Lighting rebate $_______________________

Processor’s initials____________________ Date processed ______ / ______ / ______

2 0 0 9 R E S I D E N T I A L E Q U I P M E N T P R O G R A M R E B AT E A P P L I C AT I O N P l e a s e c o m p l e te b o t h s i d e s o f t h i s a p p l i c a t i o n a n d a tt a ch c o p i e s o f i nvo i c e s . N e w E q u i p m e n t I n fo rm a t i o n (Identify each individual piece of equipment; use additional sheets if necessary.) M i d A m e ri c a n w i l l ve ri f y u n i t e ff i c i e n c i e s a s l i s te d i n t h e a p p l i c a b l e p ro d u c t d i re c to ri e s . N AT U R A L G AS E Q U I P M E N T: F U R N AC E S ; B O I L E R S ; WAT E R H E AT E R S GAMA R E F E R E N C E N O.

M A N U FAC T U R E R

M O D E L N O.

S E R I A L N O.

I N STA L L E D C O ST O F U N I T

I N STA L L AT I O N DAT E

E F F I C I E N T FA N M OTO R Y / N

E L E C T R I C E Q U I P M E N T: A I R C O N D I T I O N E R S ; H E AT P U M P S ; H E AT P U M P WAT E R H E AT E R S ARI CONDENSER CONDENSER R E F E R E N C E M A N U FAC - M O D E L N O . N O. TURER

SERIAL N O.

COIL COIL I N STA L L E D M A N U FAC - M O D E L N O. C O ST O F TURER UNIT

I N STA L L AT I O N DAT E

HSPF

C O M PAC T F L U O R E S C E N T F I X T U R E S ( H A R D - W I R E D ) F I X T U R E TY P E

L A M P WATTAG E

Q UA N T I TY

Single lamp Double lamp Th r e e l a m p Fo u r l a m p

A P P L I A N C E S ( M U ST B E E N E R G Y STA R ® R AT E D ) EQUIPMENT M A N U FAC T U R E R

M O D E L N O.

S E R I A L N O.

I N STA L L E D C O ST O F U N I T

I N STA L L AT I O N DAT E

ˆ N a tura l ga s

ˆ Propa ne

ˆ Ele c tric

For clo t h e s wa sh e r s, p lea s e c h ec k w a te r h ea te r ty p e : ˆ N a tura l ga s

ˆ Propa ne

ˆ Ele c tric

F or clo t h e s wa sh e r s, p lea s e c h ec k d ry er ty p e :

P R O G R A M M A B L E T H E R M O STAT S Q UA N T I TY

M A N U FAC T U R E R

MODEL NUMBER

I N STA L L E D C O ST

I N STA L L AT I O N DAT E

This the r m o st a t c o n t ro ls : ˆ M id A me ric a n h e a tin g ˆ M idA me ric a n c ooling ˆ B oth M idA me ric a n he a ting and cool i ng

Equipment must be installed between Jan. 1 – Dec. 31, 2009. Rebate applications must be postmarked by Jan. 31, 2010, to qualify for 2009 rebate program. Disclaimer MidAmerican does not guarantee that installation and operation of energy-efficient equipment will result in reduced usage or in cost savings. The manner in which a customer uses and maintains energy-efficient equipment affects potential cost savings. MidAmerican makes no warranties, expressed or implied, with respect to any equipment purchased or installed, including, but not limited to, any warranty of merchantability or fitness for a particular purpose. In no event shall MidAmerican be held liable for any incidental or consequential damages or injuries resulting from defective equipment or installation. MidAmerican reserves the right to cancel or change these programs at any time. MidAmerican’s acceptance of this application does not guarantee payment of rebate or acceptance of financing. Application valid Jan. 1 - Dec. 31, 2009 6-191a 2/24/09