Rebate Form 2009

2009 Watt Savers Rebate Form Effective Jan. 1, 2009 through Dec. 31, 2009

Customer Information (will also be used for customer’s rebate check): NOTE: A copy of paid receipt must accompany this rebate form. Rebates must be submitted within thirty (30) days of the installation date to be processed. Installations older than thirty (30) days will not be eligible.

Customer Name: _______________________________________ REMC Acct. #: _____________________ Address: _______________________________________________________________________________ Street

City

Zip

Home Tel.: __________________________________ Email: _____________________________________ Select rebate options:

Mail check

Apply to bill

REBATE Total: ___________________ (Office Use ONLY)

Heating & Cooling Information: Select system installed:

Heat Pump

Manufacturer:

Air Conditioner

Outdoor Coil #:

Indoor Coil #:

ARI Reference #:

ARI SEER Rating:

Cooling Tons:

ARI EER Rating #:

Cooling Tons:

Geothermal Unit Manufacturer:

Unit Model #:

ARI Reference #:

NOTE: The above model numbers should be written as they are found in the ARI directory at www.aridirectory.org. See dealer for this information. The ARI rated SEER on heat pumps and air conditioners will be the SEER used to determine rebates. Please check that your choice of equipment is an ARI certified match.

Heating & Cooling Installer/Builder Information: Installer Name: ____________________________________ Phone: _________________________________ Install Date: __________________________ Builder Name: _______________________________________

Electric Water Heater Information: Water heaters must have a .90 EF (energy factor) rating or better. See manufacturers label on the unit or ask dealer.

Size/Gallons: ________ KW: ________ EF (Energy Factor) Rating: ________ Install Date: _______________ Purchased from: __________________________________ Installer: _______________________________

I certify that this equipment has been installed and meets all requirements of Henry County REMC. Members Signature: ______________________________________________ Date: ____________________ How did you hear about this program? ___________________________ REMC Employee: ______________ Fax to: Lara Sullivan (765) 529-1667 or mail to: Henry County REMC, P.O. Box D, New Castle, IN 47362. Questions can be directed to Lara Sullivan at (765) 529-1212 or [email protected].

2009 Henry County REMC Watt Savers Rebate Program Important: Unit claims must be submitted within 30 days of unit placement date to be eligible for payment. Member must supply REMC with all information specified on rebate form in order to receive rebate. Heating and cooling systems must meet SEER ratings listed below. SEER ratings will not be rounded to a higher equivalent. All rebates are effective Jan. 1 through Dec. 31, 2009. Unit Type:

Unit Size:

Electric Water Heater

40/50 Gal. High Efficiency

$50

(Water Heater must have a .90 EF (Energy Factor) rating or better to be eligible)

80 Gal. High Efficiency

$150

Central Air

14 SEER Unit

$200

(For members purchasing new or having an existing home with central conditioners in need of replacement)

15 SEER Unit

$200

16 SEER Unit

$250

17 SEER Unit 14 SEER Heat Pump

$300 $300

15 SEER Heat Pump

$300

16 SEER Heat Pump

$350

17 SEER Heat Pump 14 SEER Heat Pump

$400 $800

15 SEER Heat Pump

$800

16 SEER Heat Pump

$900

17 SEER Heat Pump

$1,000 $1,000

Air Source Heat Pump – Electric/Electric or Dual Fuel (Electric with Fossil Fuel Backup) (For members purchasing new or replacing an air source heat pump)

Air Source Heat Pump Replacing a Standard Electric Furnace, Baseboard or Ceiling Cable (For members with an existing home or mobile home)

Geothermal Heat Pump

Rebate Value:

(For members purchasing new or replacing a geothermal heat pump)

Fax Watt Savers Rebate Form to: Lara Sullivan (765) 529-1667 or mail to: Henry County REMC, P.O. Box D, New Castle, IN 47362. Questions can be directed to Lara Sullivan at (765) 529-1212 or [email protected].