ENERGY STAR® DUCTLESS AIR SOURCE HEAT PUMP

2025 RESIDENTIAL REBATE APPLICATION

MEMBER INFORMATION

Name *

Account # *

Address where ductless air source heat pump is installed *

City *

State *

Zip *

Phone Number *

Type of Phone *

Member Type *

Homeowner

Renter

By signing this application, I certify the appliances for which I am claiming a rebate are qualifying ENERGY STAR® rated products and are installed at the address listed above which represents a valid Todd-Wadena Electric Cooperative account.

Member Signature *

clear

Date * +

EQUIPMENT INFORMATION

Manufacturer *

Model Number *

1. Did this rebate influence your decision to buy this ductless air source heat pump? *

Yes

No

2. Is this a replacement appliance? *

Yes

No

3. What is your primary heating fuel? *

Electric

Fossil Fuel

Ground Source Heat Pump

Which Size ASHP did you purchase and install?

≤1-ton, ≥14.3 SEER2 & ≥7.5 HSPF2 Rebate $150

≤1-ton, ≥16.0 SEER2 & ≥8.0 HSPF2 Rebate $250

>1-ton, ≥14.3 SEER2 & ≥7.5 HSPF2 Rebate $500

>1-ton, ≥16.0 SEER2 & ≥8.0 HSPF2 Rebate $700

RETAILER INFORMATION

Retailer/Store Name *

City, State *

Rebates are available for the purchase of new ENERGY STAR® rated ductless air source heat pumps purchased between January 1, 2025 - December 31, 2025. Rebate submittal must follow the guidelines as outlined by the cooperative. The cooperative is not responsible for inaccurate information supplied by appliance dealers. Rebates will be issued only for the products on the current list of ENERGY STAR® rated products as of the purchase date. ENERGY STAR® occasionally removes products from qualifying lists, and the cooperative will not rebate products that have been delisted as of the purchase date or are mislabeled as ENERGY STAR®. Rebate program is subject to change or cancellation without notice. Call the cooperative to verify rebate program status and availability of rebates.

IMPORTANT

Important:

• Ductless air source heat pump must be installed within Todd-Wadena Electric Cooperative’s service territory.
• Must be ENERGY STAR® rated.

• Must provide ASHP specs paperwork that show SEER2 and HSPF2 ratings.
• 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 *

Copy of ASHP specs paperwork. *

This institution is an equal opportunity provider and employer.