Rebate Request Form

Daviess-Martin County REMC 2010 Daviess-Martin County REMC Incentive Program

812- 295-4200 or 1-800-762-7362
Existing Home
Please provide the necessary information pertaining to your particular request. Rebates cannot be (Including
Type of System New Mobile or
processed without complete information and proof of purchase (invoice or receipt.) Specs Homes Modular) Check the conditions that apply
(check all that apply)
Equipment that is rebated by Daviess-Martin REMC will have a load control
switch installed on it. Electric 40, 50 or 75 gal. $50 $50 Replacing old electric water heater
Water Heater 80 gal. $150 $150 Replacing a gas/propane water heater
Name: __________________________________________________________________ With load control switch
Daviess-Martin County REMC Account #: ______________________________________ Energy Factor must Installing in a new home.
be .90 or higher
Address: ________________________________________________________________
Central Air 14 to 15.9 SEER $200 $200
Home Phone: ____________________________________________________________ Replacing an old air conditioner
Conditioner 16 to 16.9 SEER $250 $250
Work Phone: _____________________________________________________________ Installing in a new AC in a new home.
17 SEER or higher $300 $300
Please indicate the type of home you have:
With load control switch
New Construction
Existing Home All Electric 14 to 15.9 SEER $300 $300 Replacing an old heat pump
Mobile or Modular Home Heat Pump 16 to 16.9 SEER $350 $350 Installing a new one in a new home
17 SEER or higher $400 $400 Replacing a natural gas, propane, oil
HVAC Water Heater or wood furnace
With load control switch

Brand: ____________________________________ Brand: ________________________________ Heat Pump 14 to15.9 SEER $300 $300
Installing as a dual fuel system either
Purchased from: ____________________________ Purchased from: ________________________ 16 to 16.9 SEER $350 $350 replacing an existing air conditioner or
Dual Fuel 17 SEER or higher $400 $400 an existing heat pump
Outdoor Unit Model #: _______________________ Unit Model #: __________________________
Application Installing as a dual fuel system in a
With load control switch
Outdoor Unit Serial#: ________________________ Unit Serial#:____________________________ new home
Indoor Unit Model #: ________________________ Installed by: ___________________________ All Electric 14 to 15.9 SEER NA $800 To replace an old air conditioner in a
Indoor Unit Serial#:__________________________ Date Installed:__________________________ home that has:
Heat Pump 16 to 16.9 SEER NA $900
electric furnace
Installed by: _______________________________ Size (gallons): __________________________ 17 SEER or higher NA $1000 electric ceiling cable heat
Date Installed:______________________________ Efficiency Rating: _______________________ With load control switch baseboard electric heat
Size (tons or Btus): __________________________ Type of home HVAC:_____________________ other type of wall electric heaters
(Total heating needs of the home are being
ARI SEER Rating: ____________________________ Building Contractor’s Name:
met by electric resistance heating units.)
Building Contractor’s Name: __________________ ________________________________
Geothermal $1000 $1000 Installing a new one in a new home
Back-up electric heat Kw: _____________________ Heat Pump With load control switch Installing in an existing home
Primary eason for choosing electric water heater:
ETS Room Unit $30/kw $30/kw
Primary reason for choosing electric HVAC: Lower cost to install Installing a new one in a new home
ETS Whole House Unit $300 $300
Lower cost to install Safety $350 $350 Replacing a gas system
Rebate or Incentive
$400 $400
Safety
Rebate or Incentive Other:______________________________ To receive a rebate from Daviess-Martin County REMC, all homeowners must provide ARI (Air conditioning and
Refrigeration Institute) validation for all SEER ratings that can be obtained from the installing heating and cooling
Other:__________________________________ dealer. No rebate will be awarded based on HVAC dealer bid specifications, promotional material of dealer, For Daviess-Martin
manufacturer or any other source than ARI. A certificate of ARI-certified performance must be submitted. ALL
Age of replaced unit/system: Age of replaced unit/system: homeowners must complete a rebate request form and provide proof of purchase to receive any 2010 Daviess-Martin County REMC
1 to 5 years 1 to 5 years County REMC rebate. Deadline to apply for 2010 Rebate Program is Dec. 31, 2010. ALL homeowners and future Use Only:
homeowners receiving Daviess-Martin County REMC rebates agree to the future installation of
6 to 10 years 6 to 10 years load control devices on these rebated appliances to allow Daviess-Martin County REMC the Total Rebate Amount:
11 to 15 years 11 to 15 years opportunity to engage in future demand management load control procedures.
16 or more years 16 or more years Please sign here to indicate you understand these conditions:
$ _________________
_________________________________________Date:_____________