GEOTHERMAL GROUND SOURCE HEAT PUMP (GSHP)

2024 RESIDENTIAL REBATE APPLICATION

MEMBER INFORMATION

Name *

Account # *

Address where ductless GSHP is installed

City *

State *

Zip *

Phone Number *

Type of Phone *

Member Type *

Homeowner

Renter

By signing this application, I certify that the GSHP is a qualifying appliance, and that it has been installed at the address listed above and that this address represents a valid cooperative account.

Member Signature *

clear

Date * +

EQUIPMENT INFORMATION

Manufacturer *

Tons *

Annual Energy Use (kWh/year) *

Check all that apply *

Integrated ECM

Integrated Water Heater

Open Loop

Close Loop

Did this rebate influence your decision to buy this GSHP?

Yes

No

CONTRACTOR INFORMATION

Company Name *

City, State *

Rebate is available for GSHPs purchased between January 1, 2024- December 31, 2024. The GSHP must be installed where electrcity is supplied by the cooperative. Rebate subittal must follow the guidelines as outlined by the cooperative. The cooperative is not responsible for inaccurate information supplied by vendors.

IMPORTANT

• Rebate: $400/ton (must be ENERGY STAR® rated).
• GSHP must be installed within the cooperative’s service territory.
• Incomplete forms will not be processed.
• Rebate program is subject to change or cancel without notice.

• Submit completed rebate form and a copy of the original sales receipt within 90 days of purchase.

• Rebate credits under $100 will be applied to the member's account.

Copy of the original dated sales receipt *

This institution is an equal opportunity provider and employer.