CPUD: Residential Air Source Heat Pump Rebate Application

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Basic home information and the new heat pump's AHRI Certificate are needed for pre-approval.

If you are applying after installation is complete, you will need the final invoice.

Home Type*

New Construction does not qualify.

Site Built Home (4 units or less)

Manufactured Home

What is the home's primary heating system, prior to the new heat pump?*

Heat Pump

Electric Forced Air Furnace

Electric Zonal (wall, baseboards, ceiling, space heaters)

Gas or Oil Forced Air Furnace

Wood or Pellet Stove

No Existing Heat

Your home is not eligible for the rebate. Thank you for your interest.

Year home was built*

Use estimate if needed.

Home Square Footage*

Interior living space

Foundation Type*

Crawlspace

Full Basement

Half Basement

Slab

Does the home have existing Central Air Conditioning?*

Yes

No

Will your home use a backup heat source, after installation of the new heat pump?*

Yes

No

What is your backup heat source?*

Who is submitting this application?*

Contractor

Customer

Contractor Name*

Contact Person*

Contractor Phone*

Contractor Email*

Enter Email Confirm Email

Is the heat pump installation complete?*

Yes

No

Proposed Installation Date*

If work is not completed within the 6-month pre-approval period, a new application must be submitted.

Installation Date*

AHRI Certified Reference Number*

The contractor is to provide the AHRI information for the installed system.

AHRI Certified Reference Number*

Manufacturer*

Outdoor Unit Model Number*

Upload AHRI Certificate*

Drop files here or

Max. file size: 20 MB.

Upload Final Invoice*

Drop files here or

Max. file size: 20 MB.

Applicant Name*

First Last

Installation Address*

Street Address City State ZIP Code

Is there a different postal Mailing Address?*

Yes

No

Mailing Address*

Street Address City State ZIP Code

Utility Account Number (if known)

Applicant Phone Number*

Applicant Email*

Enter Email Confirm Email

Are you the Utility Account Holder?*

Yes

No

Utility Account Holder's Name (if different than applicant)*

What is your relationship to the utility account holder?*

Homeowner

Landlord or Property Manager

Family

Tenant or Resident

Other

Applicant Release*

I have read and understand this application, including the Terms and Conditions linked at the end of this form.

I agree.

Application Notes

Please insert any notes that you would like us to review with your application. (This is not required to submit the application.)

Eligible homes

Qualified projects

Minimum efficiency requirement

Amounts

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For Completed PTCS Installations

Eligible homes

Qualified projects

Minimum efficiency requirement

Amounts

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