Rebate Program Application

Transcription

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2 RebateProgramApplication TermsandConditions ThisrebateprogramisavailabletoMid SouthSynergyResidentialMembersandapplies toenergyefficiencyprojectscompletedonnewandexistinghomesservicedbymid SouthSynergy. The Rebate applies to Starting January 01, 2015 to December 31, (or while funds last) Submissionofapplicationdoesnotguaranteearebate,asthefundingfortheprogram islimited.oncefundsbudgetedfortherebateprogramareexhaustedtheprogram stops. Memberscanapplyforonerebatepercategoryperyear.Pleasekeepacopyofthe receipt,applicationandanyotherdocumentationforyourrecords. Applicationsmustbecompletedandsubmittedwithin90daysofinstallationor improvements. Mid SouthSynergyreservestherighttoverifyallprojectsinordertomeetminimum programguidelines.themembermaylosetherebateifmid SouthSynergycannot verifytheinformationprovidedontheapplicationform. Afterallprogramrequirementsaremet,arebateintheformofacheckwillbeissuedto thememberwithin3 4weeks Mid SouthSynergyreservestherighttodenyrebatesbasedonpoororientationofthe concernedrebateprogram. Mid SouthSynergyreservestherighttomakechangestotheprogramwithoutnotice. Toobtainfurtherinformation,pleasechecktheMid SouthSynergyWebsiteat

3 ENERGY STAR APPLIANCE : $ PER APPLIANCE (UPTO $ TOTAL) Rebate only applies to Energy Star rated appliances. Appliances include HVAC Window Unit, Refrigerator, Freezer, Clothes Washer and Dishwasher All appliances must be new and installed within Mid-South Synergy service area. Member must provide proof of disposal of the old replaced appliance. The appliance must be installed within 30 days of purchase To receive the rebate: Rebate program application, an itemized and dated invoice from the retailer (including date, retailers name, product description and price), Energy Star logo from packaging. Appliance Type Manufacturer Model Number Serial Number PROGRAMMABLE THERMOSTAT: $25 PER UNIT Limit to one thermostat per member account The unit must be installed in a residence in the Mid-South Synergy service area. Manufacturer s installation procedures must be followed. The unit must be installed within 30 days of purchase To receive the rebate: Rebate program application, an itemized and dated invoice from the retailer (including date, retailers name, product description and price), and the logo from the packaging. Manufacturer Units Purchased Retailer Place(s) Where Unit is Installed HVAC TUNE-UP : UPTO $ PER TUNE-UP The tune-up must be performed at a residence in the Mid-South Synergy service area. Mid-South Synergy Energy Audit must be performed prior to the HVAC tune-up. The tune-up must consist of the following - Checking and adjusting belt tension - Cleaning and lubricating the indoor blower unit - Replacing filters - Cleaning inside the A coil - Checking the thermostat, wiring and other electric parts To receive the rebate: Rebate program application and a receipt from a qualified contractor stating that the above work was completed.

4 I, certify the completion of the HVAC tune-up by checking the following Checking and adjusting belt tension Cleaning and lubricating the indoor blower unit Replacing filters Cleaning inside the A coil Checking the thermostat, wiring and other electric parts Service Date (MM/DD/YYYY) Service Cost Company Name Technician Signature HVAC UPGRADE : 1 SEER - $ AND 1 SEER - $ Program Requirements: The installation must be completed in accordance to the following recommended procedures: - 1 SEER High Efficient Electric Heat Pump the baseline replacement model is a 14 SEER with an HSPF 8.2 while the 15 SEER has an HSPF of 8.2 or greater - 1 SEER High Efficient Electric Heat Pump - the baseline replacement model is a 15 SEER with an HSPF of 8.2 while the 16 SEER has an HSPF of 9.0 or greater To receive the rebate: Rebate program application and a receipt with the ARI designation of the qualifying installation from the contractor. (Limit one rebate per member) Brand Cost AC Model Number AC Serial Number HSPF AC Seer Company Name Installer Signature ATTIC INSULATION: $ *(Prior Energy Audit Required) Must have original insulation of less than or equal to R8 (3.75 inches or less) Must upgrade to R38 or greater (17 inches or more) Limited to homes with electric resistance heating and cooling Does not apply to mobile homes, garage or unconditioned spaces Must provide receipt as proof of completed installation in accordance to program requirements.

5 To receive the rebate: Rebate program application and Receipt from installer as proof of completed installation in accordance to program requirements. (Prior energy audit required) Type And Brand Square Feet Installed Starting "R" Value Ending "R" Value MARATHON WATER HEATERS: $ Marathon Water Heater must be purchased from Mid-South Synergy Must have an energy factor of.94 or higher The unit must be 30 gallons or larger The unit must be installed within 30 days of purchase. To receive the rebate: Rebate program application, proof of completed installation in accordance to the above specifications. Model Number Serial Number Energy Factor Rating Size in Gallons Date Purchased (MM/DD/YYYY) Date Installed (MM/DD/YYYY)

6 MEMBER INFORMATION Member Name : Mid-South Synergy Account Number : Billing Address : Service Address : Home Phone Number : Cell Phone Number : Rebate Home Type : NEW EXISTING Rebate Home Ownership : OWNED RENTAL Rebate Home Specifications : HOUSE MOBILE HOME APARTMENT By signing this form, the member agrees the equipment listed on this form has been selected and installed in accordance with Mid-South Synergy Rebate Program guidelines. Homeowners and/or contractor(s) understand that Mid-South Synergy reserves the right to conduct inspections prior to issuance of the rebate. Homeowner Signature : Contractor Signature : Total Rebate Amount Requested : Date :