This completed form must be returned to the REMC with a copy of the paid
billing receipt or other
proof of purchase that shows what was purchased in detail, where you purchased
it, and who
made the purchase. The deadline to apply for a rebate is
December 31, 2008.
The program
is subject to change without notice.
o Installation
of a new air-to-air heat pump system
o
Installed in a new home
o Installation of a geothermal heat pump system
o
Replacing an existing fossil fuel system
The unit
must be an installation in a new home or building
or a replacement of a fossil fuel heating system in and existing home or
building. The unit must have electric backup heat. Dual-fuel
systems or replacement of electric heating systems do not qualify for rebates.
Brand
________________________________
Outdoor unit serial # _____________________
Indoor unit model
#_____________________
Outdoor unit model #_______________________
Indoor unit serial
#______________________ Purchased from
__________________________
Size (tons or Btu's)
___________________ Installed
by ______________________________
Back-up electric heat
KW _______________ Date unit installed
________________________
SEER rating (13
minimum)
______________ Building
contractor's name _________________
Primary reason for
choosing an electric heat pump or geothermal system:
o
Cost
of operation
oSafety
oIncentive
oOther
(please list)________________
If replacement, type
of unit
replaced:
oLP gas
heat oNatural
gas heat oWood
heat
oOil
heat
Age of replaced unit /
system:
o1 to
5 years o6
to 10 years
o11 to 15 years
o16 or more years
All installations are subject to a
verification inspection by Jackson County REMC.
I certify that the
above described equipment has been installed and is in full operating
condition.
REMC Customer
signature ________________________________________________________
REMC customer name
(please print) _______________________________________________
Mailing Address
________________________________________________________________
REMC account #
___________________ Daytime telephone #
________________________