Heat Pump Registration Form

Account Information

First

Last

Account Number

Map Location

Contact Information

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Phone Number

Email (if applicable)

Member Type

If Other, please explain:

New Construction or Replacement

New Construction

Replacement

Equipment Information

Pick Equipment Type

Manufacturer:

Model Number AAHP or GHSP:

Indoor Air Handler Model Number

Indoor Air Handler Electric?

Yes

If electric, what size of KW is the unit?

If not electric, please indicate whether system is natural gas or propane back up.

Natural Gas

Propane

What is the Heating Seasonal Performance Factor HSPF/HSPF2 or Coefficent of Performance COP Rating of unit?

Contractor Information

Contractor's Name

Address

City/Town

State/Province

ZIP/Postal Code

Contact Person

Contractor's Phone Number

Ext:

Date of Purchase

Requirements for rebate

Copy of installer's invoice

A copy of the installer's invoice is required to receive rebate.

One file only.
20 MB limit.
Allowed types: gif, jpg, png, svg, pdf, png.

NOTE: All rebates are subject to change.