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A Touchstone Energy Cooperative The power of human connections
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Energy Efficiency Rebate Request Form
Energy Efficiency Rebate Request Form
Name
Account #
Phone #
Alt. Phone #
Email
Mailing Address:
Street
City
State
Zip Code
Address of Installation (if different from above):
Street
City
State
Zip Code
Rebate Program
Which rebate(s) are you applying for?
Please check all that apply, then complete
the form sections that appear below.
Air Conditioning and Heat Pump Rebate
Marathon Water Heater Rebate
Heat Pump Water Heater Rebate (ENERGY STAR Qualified)
Air Conditioning and Heat Pump Rebate
Type:
Heat Pump
Conventional
Dual Fuel
Brand
Sq. Ft. of Conditioned Space
Condenser Model #
Air Handler Model #
HVAC Contractor Information:
Company Name
State HVAC Lic. #
Contact Name
Address
City
State
Zip Code
Phone #
Fax #
Marathon Water Heater Rebate
Model #
Serial #
Size in Gallons
Where Purchased
Install Date
Heat Pump Water Heater Rebate (ENERGY STAR Qualified)
Manufacturer
Model #
Serial #
Where Purchased
Install Date
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Become a Member
Service Area
Rates and Service Fees
Residential Rates Comparison
Billing and Payment Options
Electric Service Installation
Line Extension Policy
Area Lighting
Solar and Wind Systems
Energy Efficiency Rebates
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