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2015 Residential Incentives: Water Heaters and Drain Water Heat Recovery
PLEASE complete ALL sections and sign form to ensure proper and prompt payment of rebate.
Member Address Information (person receiving rebate)
First Name
Last Name
Address
Account Number
City
Equipment Location Information
First Name
State
Account Number
City
Check the ACCOUNT TYPE
where equipment is located
Email Address
Check if same address as above:
Last Name
Address
Zip
Phone
State
Residence Only
Resid./Farm
Resid./Business
Farm Only
Business Only
Commercial/Indust.
Zip
Apart.Bldg/Unit
Phone
Email Address
Check if you are a builder/developer
and building is not yet owned by
live-in residents: "Spec Building"
Installation and Equipment Information
DATE INSTALLED
Equipment Incentives and Code Tables
WATER HEATER TYPE REPLACED:
New Construction
Replaces Electric
Other
Replaces LP Gas
Replaces Natural Gas
None - Drain Water Heat Recovery with existing water heater
INSTALLER:
Owner
Utility
Contractor
Business Name (retailer or installing contractor)
New Electric Water Heating Equipment
Code Rebate
ENERGY STAR® Heat Pump Water Heater (stand alone units)
HPWH
$650
Add-On Heat Pump Water Heater (EF ≥ 2.0)
AOWH
$300
ENERGY STAR Solar Water Heater (with Electric Backup)
SOWH
$350
Resistance Storage Unit with geothermal heat recovery desuperheater (50-55 gallon, EF ≥ 0.95)
DSWH
$150
Resistance Storage Unit (One per home, 50-55 gal., EF ≥ 0.95)
ESWH
$50
Drain Water Heat Recovery (requires electric water heater)
Address
Code Rebate
Drain Water Heat Recovery Pipe (DWHR)
City
State
DWHR
$450
Zip Code
See Terms and Conditions on back of form.
New Water Heater Information
Code
Brand
Model
Tank Size
(gal.)
Serial
Energy
Factor
Installed
Cost
Rebate
DWHR Pipe
Installed
Length
Cost
(inches)
Rebate
Drain Water Heat Recovery Information
Brand
Model
Serial
DWHR Pipe
Existing Water Heater*
* Required if not installing new water heater
TOTAL REBATE
Attach proof of purchase.
Member Agreement (Must Sign)
I verify that the above described equipment was installed on the date and location specified. I agree to all program requirements provided (either separately or
on back of this form) and that my electric Cooperative reserves the right to inspect all equipment and verify information before issuing a rebate.
Member Signature
Office Use Only:
Date
Cooperative ID
Notes:
Authorized Amount
Employee Name
Form R3 (Rev. 4/15)
Terms and Conditions - Water Heaters and Drain Water Heat Recovery Incentives
Program Offer: The Program covers products purchased and/or services rendered on or after January 1, 2015.
Eligibility Criteria for Water Heaters:
General Terms and Conditions
1. The water heating equipment must be electric.
The Cooperative must supply all electricity to the equipment for which the
rebate is being paid.
2. Water heaters must be used for domestic water heating only and cannot be
used in conjunction with radiant space heating systems (e.g. boiler for infloor or baseboard heating).
Application Information: Missing or incorrect information on the application
may delay processing and delivery of the rebate. An invoice is required and
should include specific product information, including the brand, model, serial
number and date of purchase of the energy efficient measures. Other
information including manufacturer's equipment performance sheets may be
required upon request.
3. Electric storage water heaters must have a 50 to 55 gallon storage tank.
4. Electric resistance units must have an Energy Factor of 0.95 or higher.
5. Electric water heaters not supplemented by geothermal or solar equipment
must be energized.
6. There is a limit of two water heater unit rebates per home.
7. Stand-alone resistance storage water heaters (no geothermal or solar
assistance) are limited to one per home unless the units are separated by 30
feet of distance where deemed practical to better serve the hot water needs
of the home (please note this on the form if this applies to your installation).
8. Solar water heaters and integrated heat pump water heaters must be
ENERGY STAR® qualified units.
9. Electric storage water heaters and add-on heat pump water heaters must
have GAMA/AHRI certified capacity and energy factor ratings.
10. Add-On Heat Pump and Solar water heaters must use a supplemental
electric storage tank with a minimum 40 gallon tank.
The Cooperative reserves the right to verify sales transactions and to have
reasonable access to the Member's facility to inspect pre-existing equipment (if
applicable) and energy efficient measures installed under this program.
Warranty Information: The Cooperative makes no warranties, expressed or
implied, with respect to equipment operation, material, workmanship or
manufacturing. The Cooperative does not guarantee that a certain level of
energy or cost savings will result from the use of products covered by this
program.
Limitation of Liability: The Cooperative's liability in connection with this
program is limited to paying the rebate specified when all terms and
conditions have been satisfied. Under no circumstances shall the Cooperative
be liable for any consequential or incidental damages or tax liability resulting
from participation in this program.
Participant Certification: Participating Member certifies that he/she
purchased and installed the equipment listed on their application at the
defined location served by the Cooperative. The Member agrees that all
information provided is true and that he/she has conformed to all program
requirements. If the equipment and application does not comply with the
Cooperative's rules and qualifications, the rebate amount may be denied or
adjusted.
1. Water heating equipment for the building must be electric.
Program Changes/Termination: The Cooperative reserves the right to
extend, modify (including incentive levels) or terminate this Program at any
time without prior or further notice. The Member is responsible for checking
with the Cooperative to determine whether the program has been changed or
is still in effect.
2. Homemade systems are not eligible for the incentive. Manufacturers with
DWHR systems currently pre-approved for this incentive are as follows:
Members must apply for rebates within six (6) months of the purchase
date (as shown on the Member's invoice). Past eligibility, however, does not
guarantee that equipment will meet criteria for current programs in effect.
Eligibility Criteria for Drain Water Heat Recovery Pipe Systems
•
•
•
•
•
Renewability Energy Inc. (PowerPipe, available at Home Depot)
ReTherm Energy Systems Inc. (ReTherm)
Watercycles Energy Recovery Inc. (Watercycle)
Waterfilm Energy Inc. (GFX)
Inventroment Inc. (ECO-GFX)
If you plan to purchase a unit manufactured by a company not listed above,
please call the Cooperative first to see if it will qualify.
If not installing a new water heater, information for the existing electric water
heater must be provided where indicated on form.
Form R3 - Terms and Conditions (Rev. 4/15)