Vectren Indiana 2018 Residential Rebate Application - PDF document

1 Vectren Indiana 2018 Residential Rebate
Vectren Indiana 2018 Residential Rebate Application CUSTOMER AND CONTRACTOR INFORMATIONCustomer / Account Holder Information Total Rebate Requested First and last name of Account Holder (or Tenant name if completed by Landlord)Email AddressAlternate Phone NumberVectren Account Number (REQUIRED—as shown on your utility bill)Service Type (REQUIRED—please Vectren Natural Gas Service + Vectren Electric Service Vectren Electric Service Only Vectren Natural Gas Service OnlyInstallation Address AddressInstalling Contractor Information Email AddressAlternate Phone NumberAddressContractor Federal Tax ID Number (TIN/EIN) or SSN (complete if receiving the rebate)Federal Tax Classification Individual/Sole Proprietor Exempt Mailing Information for Rebate Check Check Payable to: Customer/Account Holder Contractor Property Owner/Landlord (if not account holder) Property Owner's Phone NumberAddressSignatures I hereby certify that: 1) The information contained in this application is accurate and complete; 2) All rules of this incentive application have been followed; 3) I have read and understand the Terms and Conditions found at Vectren.com/SaveEnergy. I agree to verification of equipment installation which may include a site inspection by a program or utility representative. I understand that I am not allowed to receive more than one incentive from this program on any one piece of equipment. I hereby agree to indemnify, hold harmless and release the utility and program administrator from any actions or claims in regard to the installation, operation and disposal of equipment (and related materials) covered herein, including liability from any incidental or consequential damages.If, as the Installing Contractor, I am submitting an Instant Discount application, I certify that I have provided the full rebate as an instant discount to the account custo

2 mer listed on this application. I have e
mer listed on this application. I have explained to the customer that the rebate he/she qualifies for has been applied as a discount off the purchase price, and he/she will not be eligible to receive a rebate for the same product(s) being submitted in the application. Submitted with this application, is the required invoice clearly itemizing the amount of the rebate provided as a discount to the customer on the line item marked "Vectren Rebate Instant Discount." Customer / Account Holder Signature Date Contractor Signature DateCustomer / Account Holder signature is required. For the Instant Discount Option, the Contractor’s signature is required.Was equipment self-installed? Yes 3 OF 6 EQUIPMENT INFORMATIONVectren Indiana 2018 Residential Rebate ApplicationOnly one installation address and account number can be submitted on an application. For additional account numbers, please complete separate applications. Unit Controlled (Please Central Air Source Heat Pump Electric Furnace with A/C Electric Furnace no A/C Gas Furnace/Boiler with A/C Gas Furnace/Boiler no A/CPlease the requested rebate. This page may be copied for multiple units. Please print legibly.Wi-Fi THERMOSTAT ($50 REBATE) Manufacturer/MakeModel NumberSerial NumberDate Installed Homes must have Vectren natural gas or Vectren electric as the primary heat source to be eligible for this rebate. Dual fuel systems are eligible. If replacing existing (non Wi-Fi) thermostat in newly constructed home, thermostat is eligible.Must be Wi-Fi capable without the use of additional equipment and connected to the internet for programming and adjusting remotely.Serial number

3 is preferred, but not required.Household
is preferred, but not required.Household limit is two Wi-Fi enabled or smart thermostats. SMART THERMOSTAT ($75 REBATE) Manufacturer/MakeModel NumberSerial NumberDate Installed Homes must have Vectren natural gas or Vectren electric as the primary heat source to be eligible for this rebate. Dual fuel systems are eligible. If replacing existing (Non Wi-Fi) thermostat in newly constructed home, thermostat is eligible.Must be Wi-Fi capable without the use of additional equipment and connected to the home. Must be ENERGY STAR certified smart thermostat. Household limit is two Wi-Fi enabled or smart thermostats. 4 OF 6 EQUIPMENT INFORMATIONVectren Indiana 2018 Residential Rebate ApplicationBOILER Date InstalledManufacturer/Make 90% AFUE$300 RebateHomes must have Vectren natural gas as the primary heat source to be eligible for this rebate.FURNACE Date InstalledManufacturer/Make  95% AFUE $250 Rebate  97% AFUE $300 Rebate Homes must have Vectren natural gas as the primary heat source to be eligible for this rebate.Furnace must be primary heat source for home’s living space and be a sealed combustion unit.Systems supplementing gas space heating with an air source, dual-fuel or geothermal heat pump are CENTRAL AIR CONDITIONING UNIT AHRI Reference NumberOUTDOOR Unit Manufacturer/MakeINDOOR Unit Manufacturer/MakeHomes must have Vectren electric service to be eligible for this rebate.Purchase must be a high-efficiency electric central air conditioner as part of an AHRI rated qualifying system.An AHRI certificate or certificate number must be submitted with the application. The Air-Conditioning, Heating and Refrigeration Institute (AHRI) maintain a directory of certified product performance for HVAC equipment. To obtain a copy of the AHRI certificate and certificate reference number, please visit: www.ahridirectory.org/ahridirectory/pages

4 /home.aspx. ECM (Electronically Commutat
/home.aspx. ECM (Electronically Commutated Motor) New Furnace or Air Handler with ECMNew ECM Only (in existing furnace ):Replaces standard motor Manufacturer/Make Homes must have Vectren electric service to be eligible for this rebate.ECM can be a retrofit or part of a new HVAC system. qualify.ECM must be on furnace or air handler of whole home system. AIR PURIFIER ($25 REBATE) Manufacturer/MakeModel NumberSerial NumberDate InstalledHomes must have Vectren electric service to be eligible for this rebate.Must be ENERGY STAR certified air purifier 5 OF 6 EQUIPMENT INFORMATIONVectren Indiana 2018 Residential Rebate Application HEAT PUMPS AHRI Reference Number Yes If yes, what is the fuel source? OUTDOOR Unit Manufacturer/MakeINDOOR Unit Manufacturer/Make Homes must have Vectren electric service as the primary heat source to be eligible for this rebate.Back-up heat must be electric, systems with gas furnace back-up are qualify.Both the condenser and indoor unit must be replaced as part of an AHRI rated qualifying system.An AHRI certificate or certificate number must be submitted with the application. The Air-Conditioning, Heating and Refrigeration Institute (AHRI) maintain a directory of certified product performance for HVAC equipment. To obtain a copy of the AHRI certificate and certificate reference number please visit:www.ahridirectory.org/ahridirectory/pages/home.asp. DUAL-FUEL HEAT PUMP AHRI Reference Number Yes If yes, what is the fuel source? OUTDOOR Unit Manufacturer/MakeINDOOR Unit Manufacturer/Make Homes must have dual-fuel (Vectren natural gas + Vectren electric service) as the primary heat source to be eligible for this rebate. qualify.Both the condenser and indoor unit must be replaced as part of an AHRI rated qualifying system.An AHRI certificate or certificate number must be submitted with the application. The Air-Conditioning, Heating and Refrigera

5 tion Institute (AHRI) maintain a directo
tion Institute (AHRI) maintain a directory of certified product performance for HVAC equipment. To obtain a copy of the AHRI certificate and certificate reference number, please visit: www.ahridirectory.org/ahridirectory/pages/home.asp. DUCTLESS HEAT PUMP AHRI Reference NumberIf gas is primary heat source, specify Previously Unconditioned Space OUTDOOR Unit Manufacturer/MakeINDOOR Unit Manufacturer/MakeHomes must have Vectren electric service to be eligible for this rebate.If home has Vectren electric service but natural gas is used as the primary heat source, then rebates are only available for installations in a new room addition or previously unconditioned space.Installation must replace electric resistance heat.An AHRI certificate or certificate number must be submitted with the application. The Air-Conditioning, Heating and Refrigeration Institute (AHRI) maintain a directory of certified product performance for HVAC equipment. To obtain a copy of the AHRI certificate and certificate reference number, please visit: www.ahridirectory.org/ahridirectory/pages/home.asp. 6 OF 6 EQUIPMENT INFORMATIONVectren Indiana 2018 Residential Rebate Application HEAT PUMP WATER HEATER Location of Water HeaterEnergy Factor (EF)Interior Water ClosetManufacturer/MakeHomes must have Vectren electric service to be eligible for this rebate.Heat pump water heaters must have an Energy Factor (EF) of 2.0 or greater to qualify. POOL HEATER Manufacturer/MakeCoefficient of Performance (COP)Homes must have Vectren electric service to be eligible for this rebate. VARIABLE-SPEED POOL PUMP Operating Days Per YearVariable-Speed Pool PumpManufacturer/Make Homes must have Vectren electric service to be eligible for this rebate. qualify for a rebate.EXISTING EQUIPMENT (if applicable)Complete the applicable elds below if replacing existing equipment Type of Equipment Being Replaced (Please Nonpro

6 grammable Thermostat Furnace Electronica
grammable Thermostat Furnace Electronically Commutated Motor (ECM) Water Heater Inoperable, but repairable Inoperable, not repairableOld Unit Manufacturer/MakeOld Unit Tons Type of Equipment Being Replaced (Please Nonprogrammable Thermostat Furnace Electronically Commutated Motor (ECM) Water Heater Inoperable, but repairable Inoperable, not repairableOld Unit Manufacturer/MakeOld Unit Tons 4 4 4 4 4 4 4 4 4 4 4 4 4 Vectren Indiana 2018 Residential Thank you for participating in Vectren’s Indiana Residential Rebate Program! Refer to the information below to ensure you are eligible for program rebates and your application is complete. Please retain a copy of your completed application and all invoices for your records. Visit vectren.com/SaveEnergy to apply online and view complete terms and conditions.Need Help? For assistance completing this application, call 1-866-240-8476or email SaveEnergy@vectren.com to reach a Vectren Energy Efciency Advisor. What You Will NeedA copy of your itemized invoice that contains all equipment and installation Step 3: Submit Paperwork IN RESIDENTIAL REBATE APPLICATION 2018 HOW TO APPLY FOR A REBATE Complete ApplicationUnless noted otherwise, all elds must be completed on the application to receive a rebate. Incomplete applications will result in processing delays.Sign ApplicationThe application must be signed in the space provided on page 2 of the application to receive a rebate. If Instant Discount is given by the contractor, contractor's signature is also required.Attach Invoice(s)Ensure that you have attached a copy of all equipment invoices and the AHRI Certicate of Product 10160161-866-240-8476 | VECTREN.COM/SAVEENERGY 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4