Jackson County REMC 2008 Electric Water Heater

Incentive Claim Form

A 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.

oInstallation in new home or building (40 gallon or larger)

 

oReplaced fossil fuel water heater with new electric unit (40 gallon or larger)

 

Replacement of an existing electric water heater does not qualify for an incentive.

Brand ________________________________     Purchased from __________________________

 

Model # ______________________________     Installed by  _____________________________

 

Serial #  ______________________________     Date unit placed__________________________

 

Gallon capacity  ________________________    Type of home heating system  ______________

 

Maximum wattage rating _________________     Building contractor's name _________________

 

 

Primary reason for choosing an electric water heater:

  oCost less to install   oSafety        oIncentive     oOther (please list)________________

 

If replacement, type of unit replaced:

  oLP gas                     oNatural gas          oWood          oOther

 

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 # ________________________

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