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2. 
3. Heat Pump Rebate Application

   Limit one rebate per household per program year. Must be a customer in good standing of the IELD. Products must be installed by a licensed contractor. Customers are strongly encouraged to complete a no-cost Home Efficiency Audit or Air Source Heat Pump Assessment prior to their project. Submissions valid from 1/1/23-12/31/23. IELD reserves the right to end these rebates at any time.

7. Customer Information
9. Electric Account #*
10. First Name
11. Last Name*
13. Phone Number
14. Email Address
15. Service Address*
17. Mailing Address
    (if different from service address)
18. City
19. State
21. Zip
22. Requested Rebate *
    -- Select One --Air Source Heat Pump $1,000Ductless Mini-Split Heat Pump $1,000

    Select eligible measures.
23. Integrated Controls
    Number of integrated controls installed. Rebate of $100 per indoor unit, up to $400. (Dual Fuel Only)
25. Total Rebate Amount Requested*
29. Contractor Information
31. Company Name
33. Contact Person*
34. License Number *
35. Is technician NATE Certified?
    -- Select One --YesNo

    Not Required for Rebate Eligibility
37. Phone Number
38. Email Address
40. Mailing Address
42. City
43. State
44. Zip
46. Contractor's Invoice*
    Please upload invoice showing required information and proof of purchase. Invoice should include the name, license number, address and phone number of the contractor that completed the installation.
50. New Equipment Installed
    (Please review this section with your contractor)
52. Type of Equipment Installed*
    -- Select One --New ConstructionReplacement SystemAdding to Existing DuctworkNew or Additional Ductwork and Air Conditioning

    Please select one
53. Manufacturer*
54. Condenser Model #
55. Coil Model #
57. TXV or EXV Installed*
    -- Select One --TXVEXV

    Thermostatic Expansion Valve or Electronic Expansion Valve required for all systems.
58. Mini Split*
    -- Select One --YesNo
59. New Unit Size (Tons)
    Note: 1 Ton=12,000 Btu/hour, needed for right sizing
61. *AHRI-Rated SEER
62. *AHRI-Rated EER
63. HSPF
65. AHRI Certificate*
    *Please upload the AHRI certificate. Contact your Heating and Air Conditioning Contractor to obtain a copy.
66. Equipment Specification Documents*
    Please upload all "cut sheets" or product specification documents associated with the heat pump system.

68. *AHRI SEER and EER rating of outdoor condenser and indoor coil working together. Rounding up of SEER/EER ratings is not acceptable.

70. Specifications

    Air Source Heat Pump: SEER>15; HSPF>9; COP>1.75 at 5 degrees at maximum capacity (NEEP Standard)

    Ductless Mini-Split Heat Pump: SEER>15; HSPF>9; COP>1.75 at 5 degrees at maximum capacity (NEEP Standard)

    
    

74. Customer Acknowledgement
    By submitting this form, I hereby certify that all information above is correct to the best of my knowledge and that I adhere to all terms and conditions of this rebate. I certify that a licensed contractor has installed the measure(s) listed, in accordance with state and local codes.
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76. 1. Receive an email copy of this form.
77. Email address

    This field is not part of the form submission.

78. Submit

* indicates a required field