Rebate Form
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Customer Rebate Form GROUND SOURCE HEAT PUMP INSTALLATION CUSTOMER INFORMATION Name of Customer
Minnesota Power Account Number
Mailing Address
City
State
ZIP
Installation Address
City
State
ZIP
Phone Number
Email Address
State
ZIP
INSTALLER INFORMATION Company Name Address
City
Phone Number
Contact Person
SYSTEM SPECIFICATIONS Manufacturer
Model Number
Number of Tons–Size
Installation Date (system operational)
Manufacturer
Model Number
Loop Type Open Closed
Forced Air Hot Water
New Home Retrofit
Desuperheater Installed Yes No
CUSTOMER REBATE $200/ton closed loop system
$100/ton open loop system
TOTAL REBATE
$
CUSTOMER AGREEMENT The information in this application is accurate and complete. My signature also indicates that I have read and understood the Rules and Requirements of the GHP rebate program, and I acknowledge and agree that Minnesota Power is not warranting any equipment nor will it be liable for any personal injury or property damage caused by the equipment. All of the listed equipment will be purchased, installed, and operating at the facility listed above, and I will provide dated invoices and other requested documentation verifying purchases. I understand that Minnesota Power may inspect and verify installation of the equipment before and after any rebate payment.
Customer Signature
Date
REBATE PROCESS Complete all appropriate information in application Sign application Attach Invoice MAIL GHP Rebate, Attn. Andrea Prunuske, 431 Charmany Dr. Madison WI 53719 EMAIL [email protected] (include scanned copy of the invoice)
Send rebate form to:
RULES AND REQUIREMENTS Qualifications GHP rebate incentives are available to Minnesota Power’s residential and commercial customers. The heat pump must be installed in homes of Minnesota Power residential customers on or before December 31, 2009. The heat pump must have a minimum Coefficient of Performance (COP) of 3.3 for closed loop and 3.6 for open loop systems. The heat pump must be installed by a certified GHP contractor. Disclaimer Minnesota Power, by providing rebate incentives, does not warrant any of the equipment installed. Minnesota Power is not responsible or liable for any personal injury or property damage caused by this equipment. Rebate incentives are subject to the availability of GHP rebate funds. Further Information If you have any questions about the program or need assistance with the application, contact Andrea Prunuske at 608-249-9322 x303. Please allow 6-8 weeks to receive your check. This form may be photocopied for further use.
Minnesota Power Account Number
Mailing Address
City
State
ZIP
Installation Address
City
State
ZIP
Phone Number
Email Address
State
ZIP
INSTALLER INFORMATION Company Name Address
City
Phone Number
Contact Person
SYSTEM SPECIFICATIONS Manufacturer
Model Number
Number of Tons–Size
Installation Date (system operational)
Manufacturer
Model Number
Loop Type Open Closed
Forced Air Hot Water
New Home Retrofit
Desuperheater Installed Yes No
CUSTOMER REBATE $200/ton closed loop system
$100/ton open loop system
TOTAL REBATE
$
CUSTOMER AGREEMENT The information in this application is accurate and complete. My signature also indicates that I have read and understood the Rules and Requirements of the GHP rebate program, and I acknowledge and agree that Minnesota Power is not warranting any equipment nor will it be liable for any personal injury or property damage caused by the equipment. All of the listed equipment will be purchased, installed, and operating at the facility listed above, and I will provide dated invoices and other requested documentation verifying purchases. I understand that Minnesota Power may inspect and verify installation of the equipment before and after any rebate payment.
Customer Signature
Date
REBATE PROCESS Complete all appropriate information in application Sign application Attach Invoice MAIL GHP Rebate, Attn. Andrea Prunuske, 431 Charmany Dr. Madison WI 53719 EMAIL [email protected] (include scanned copy of the invoice)
Send rebate form to:
RULES AND REQUIREMENTS Qualifications GHP rebate incentives are available to Minnesota Power’s residential and commercial customers. The heat pump must be installed in homes of Minnesota Power residential customers on or before December 31, 2009. The heat pump must have a minimum Coefficient of Performance (COP) of 3.3 for closed loop and 3.6 for open loop systems. The heat pump must be installed by a certified GHP contractor. Disclaimer Minnesota Power, by providing rebate incentives, does not warrant any of the equipment installed. Minnesota Power is not responsible or liable for any personal injury or property damage caused by this equipment. Rebate incentives are subject to the availability of GHP rebate funds. Further Information If you have any questions about the program or need assistance with the application, contact Andrea Prunuske at 608-249-9322 x303. Please allow 6-8 weeks to receive your check. This form may be photocopied for further use.
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