2012 Energy efficiency & conservation incentives
Appliance, HVAC, & Water Heater
Cooperative logo
Return completed form and required paperwork to:
Heartland Power • PO Box 70 • St. Ansgar, IA 50472-0070
Member Name:_____________________________________
E-mail: _________________________________________
Address:___________________________________________
Account Number: _________________________________ City:______________________ State:_______ Zip:_______
Date: _____________ Phone: _______________________
Incentive Used for: c Residence
c Farm
ENERGY STAR® Appliance and
Recycling
4Include a copy of ENERGY STAR® label
with rebate form and invoice/ receipt.
4Visit www.energystar.gov to verify
ENERGY STAR® rating.
c
c
c
c
c
Dehumidifier ($25)
Refrigerator ($25)
Room Air Conditioner ($25)
Dishwasher ($25)
Water Heater Fuel
c_ Electric c Nat Gas c LP Gas
Clothes Washer ($25)
Fuel of Water Heater
c_ Electric c Nat Gas c LP Gas
Fuel of Dryer
c_ Electric c Nat Gas c LP Gas
Include recycling receipt showing unit was in
working order when recycled for the following:
c Recycled Freezer ($25)
c Recycled Refrigerator ($25)
c Recycled Room Air Conditioner ($25)
Total Energy Star Appliance
Rebate Amount Requested: ____________
Conservation
4Submit rebate form with copy of your
invoice/receipt.
Check all that were installed in 2012:
c Flow Restrictors - Faucet
______ x $1/unit =______
c Flow Restrictors – Shower
______ x $5/unit =______
c Energy Saving Power Strip / Smart Strip
______ x $5/unit =______
Total Conservation
Rebate Amount Requested: ____________
c Commercial
c Industrial
c Institutional/Government
c Other________
All Rebates
4Must be purchased, installed and/or recycled in 2012 (Jan 1 – Dec 31, 2012).
4Rebates are in place through December 31, 2012 or until funds, by incentive or in total, are depleted.
4Rebate application form and copy of your receipt must be submitted by Jan. 10, 2013.
However, members are encouraged to submit rebate form and copy of your receipt as
soon as equipment is purchased and installed for best rebate fund availability.
Central Air Conditioning & Heat Pump
4SEER and EER ratings must meet or exceed those specified below.
4Submit rebate form with copy of your invoice showing SEER or EER rating.
System Type: (Check one)
c Central Air Conditioning & Mini-Splits. . .
SEER 14.0
Tons: _______ x $40/Ton =__________________
SEER 15.0
Tons: _______ x $60/Ton =__________________
SEER >=16.0
Tons: _______ x $80/Ton =__________________
c Comm AC and PTACs >=11.0 EER Tons: _______ x $40/Ton = _________________
c Comm ASHP & PTHPs >=11.0 EERTons: _______ x $120/Ton = ________________
c Air-Source Heat Pump SEER >=14.0Tons: _______ x $120/Ton = ________________
or HSPF>=7.7
c Geo-thermal Heat Pump Tons: _______ x $200/Ton = ________________
Brand name: _______________________________________________________________
Nominal tons/Condenser unit(s): _______________________(rounded to nearest 1/2 ton)
Condenser Model Number(s): _________________________________________________
Evaporator (Coil) Model Number(s): ____________________________________________
Manufacturer SEER Rating(s): __________________________________________________
c New Construction
Fuel Being Replaced: c LP c Natural Gas c Other ________________________
Back-Up Fuel Used: c LP c Natural Gas c Other _______________________
Total Cooling System Rebate Amount Requested: _______________
Water Heaters
4Electric water heater must have energy factors (EF) indicated below.
4Must be controlled by cooperative’s load control program.
4Rebate cannot exceed cost of purchase and installation or repair.
4Submit rebate form with copy of your invoice/receipt showing the efficiency or repair.
c 50-79 Gallon - E.F. 0.90 or above
EF______ Gallons_____ $250/Unit _______ c 80 Gallon+ - E.F. 0.90 or above
EF______ Gallons_____ $550/Unit _______ c Heat Pump Water Heater - Load control not required
$700/Unit _______
c Solar Storage Water Heaters w/ Electric Back-Up $700/Unit _______
c Water Heater Repair
$75/repair _______
Total Water Heater Rebate Amount Requested:
_______________
Office use only
c Approved
c Not Approved – Reason ______________________________________ c Please check if this member is new to water heater load control.
Total rebate issued $__________________________________________________________
I certify that the rebate payments requested were purchased and/or installed after December 31, 2011 and before January 1, 2013.
Cooperative representative:____________________________________________________ Date______________________________
2012 Energy efficiency & conservation incentives
Lighting
Cooperative logo
Return completed form and required paperwork to:
Heartland Power • PO Box 70 • St. Ansgar, IA 50472-0070
Member Name:_____________________________________
E-mail: _________________________________________
Address:___________________________________________
Account Number: _________________________________ City:______________________ State:_______ Zip:_______
Date: _____________ Phone: _______________________
Incentive Used for: c Residence
c Farm
c Commercial
c Industrial
c Institutional/Government
c Other________
All Rebates
4Must be purchased and/or installed in 2012 (Jan 1 – Dec 31, 2012).
4Rebates are in place through December 31, 2012 or until funds, by incentive or in total, are depleted.
4Rebate application form and copy of your receipt must be submitted by Jan. 10, 2013. However, members
are encouraged to submit rebate form and copy of your receipt as soon as equipment is purchased and
installed for best rebate fund availability.
4Use this lighting form for all lighting rebates; Residential, Commercial, Agricultural, etc.
Lighting Rebates
4Submit rebate form and a copy of your invoice or receipt.
4Rebate not to exceed cost of lamp/bulb or unit.
The following new lamps, ballasts and/or LEDs have been installed. Please check all that apply:
c LED Holiday Lights (limit 12 per account) . . ______ x $2/ string or décor item =______
c Occupancy Sensors. . . . . . . . . . . . . . . . . . ______ x $5/switch =______ Number of Fixtures controlled: ______
For lighting below, indicate technology (incandescent, CFL, metal halide….) and wattage of lamp you are replacing. Lamp Being Replaced
c CFL. . . . . . . . . . . . . . . . . . . . . . . . . . . . . ______ x $1/lamp =______
Technology ________ Watts ____
c 60 Watt CFLs or greater. . . . . . . . . . . . . . . ______ x $5/lamp =______
Technology ________ Watts ____
c Hard-Wired ENERGY STAR CFL Fixture. . . . ______ x $5/fixture =______
Technology ________ Watts ____
c Cold Cathode CFL . . . . . . . . . . . . . . . . . . ______ x $2/lamp =______
Technology ________ Watts ____
c T8 Fixtures-Retrofit only. . . . . . . . . . . . . . . ______ x $5/lamp/fixture =______
Technology ________ Watts ____
c T5 Fixtures . . . . . . . . . . . . . . . . . . . . . . . . ______ x $7.50/lamp/fixture =______ Technology ________ Watts ____
c LED Bulb or Fixture . . . . . . . . . . . . . . . . . . ______ x $2/bulb or fixture =______ Technology ________ Watts ____
c Security Lighting- LED Technology. . . . . . . . ______ x $15/fixture =______
Technology ________ Watts ____
c Ceramic Metal Halide - Replacement only. . ______ x $15/fixture =______
Technology ________ Watts ____
c Pulse Start Metal Halide - Replacement only.______ x $15/fixture =______
Technology ________ Watts ____
c HPS Fixture - Replacement only. . . . . . . . . ______ x $15/fixture =______
Technology ________ Watts ____
c LED Exit Signs . . . . . . . . . . . . . . . . . . . . . ______ x $5/sign =______
Total Lighting Rebate Amount Requested:
_______________
Office use only
c Approved
c Not Approved – Reason ______________________________________
Total rebate issued $__________________________________________________________
I certify that the rebate payments requested were purchased and/or installed after December 31, 2011 and before January 1, 2013.
Cooperative representative:____________________________________________________ Date______________________________
2012 Energy efficiency & conservation incentives
Motors, Fans and Other
Agricultural & Commercial
Cooperative logo
Return completed form and required paperwork to:
Heartland Power • PO Box 70 • St. Ansgar, IA 50472-0070
Member Name:_____________________________________
E-mail: _________________________________________
Address:___________________________________________
Account Number: _________________________________ City:______________________ State:_______ Zip:_______
Date: _____________ Phone: _______________________
Incentive Used for: c Residence
c Farm
c Commercial
c Industrial
c Institutional/Government
All Rebates
4Must be purchased, and/or installed in 2012 (Jan 1 – Dec 31, 2012).
4Rebates are in place through December 31, 2012 or until funds, by
incentive or in total, are depleted.
4Rebate application form and copy of your receipt must be submitted by
Jan. 10, 2013. However, members are encouraged to submit rebate
form and copy of your receipt as soon as equipment is purchased
and installed for best rebate fund availability.
4*Fans must be AMCA or BESS Lab rated*
4Submit rebate form and a copy of your invoice or receipt.
4Rebate not to exceed cost of efficiency equipment.
c Other________
Custom Rebates
Please Note: Commercial and agricultural customers
that install certain types of energy saving equipment and/
or incorporate energy efficiency measures may qualify for
custom rebates. New and existing facilities are eligible.
Please contact us for details.
Prescribed Energy Efficient Equipment
The following new equipment has been installed. Please check all that apply:
c Dairy Plate Cooler / Well Water Pre-Cooler. . . . . . . . . . . . . . . ______ x $500/unit = $___________
c High Efficiency Livestock Waterers (< or = 500 watts). . . . . . . . . ______ x $50 per waterer = $___________
c Dairy Heat Recovery- with controlled electric water heater. . . . . ______ x$300/unit = $______
c Scroll Refrigeration Compressor. . . . . . . . . . . . . . . . . . . . . . . HP: ______ x $30 per HP = $___________
c Variable Frequency Drives . . . . . . . . . . . . . . . . . . . . . . . . . . . HP: ______ x $30 per HP = $___________ (max $500/drive)
c Variable Speed Compressed Air. . . . . . . . . . . . . . . . . . . . . . . HP: ______ x $30 per HP = $___________ (max $500/drive)
c High Velocity Low Speed Fan. . . . . . . . . . . . . . . . . . . . . . . . . Inches: ______ x $1 per inch diameter = $________
c Ventilation (Exhaust) Fan-21 CFM/Watt or more. . . . . . . . . . . .Inches: ______ x $1 per inch diameter = $________
c Circulation Fan- 20 lbs. of thrust/kW or more. . . . . . . . . . . . . Inches: ______ x $1 per inch diameter = $________
Total Equipment Rebate Amount Requested:
________________
Office use only
c Approved
c Not Approved – Reason ______________________________________
Total rebate issued $__________________________________________________________
I certify that the rebate payments requested were purchased and/or installed after December 31, 2011 and before January 1, 2013.
Cooperative representative:____________________________________________________ Date______________________________
2012 Energy efficiency & conservation incentives
Cooperative logo
Windows/Building Envelope
Return completed form and required paperwork to:
Heartland Power • PO Box 70 • St. Ansgar, IA 50472-0070
Member Name:_____________________________________
E-mail: _________________________________________
Address:___________________________________________
Account Number: _________________________________ City:______________________ State:_______ Zip:_______
Date: _____________ Phone: _______________________
Incentive Used for: c Residence
c Farm
c Commercial
c Industrial
c Institutional/Government
c Other________
All Rebates
4Must be purchased, installed and/or recycled in 2012 (Jan 1 – Dec 31, 2012).
4Rebates are in place through December 31, 2012 or until funds, by incentive or in total, are depleted.
4Rebate application form and copy of your receipt must be submitted by Jan. 15, 2013.
However, members are encouraged to submit rebate form and copy of your receipt as
soon as equipment is purchased and installed for best rebate fund availability.
ENERGY STAR® Window Rebates
4Primary heating source must be electric.
4Qualifying windows must be a minimum of Eight
(8) square feet.
4Window must be Energy Star® rated. (U-factor of
0.35 or less).
4Maximum of $150 rebate per member.
4The rebate form, a copy of your receipt and the
Energy Star® label must be submitted by January
15, 2013 in order to receive a rebate.
4The amount of the rebate given will not exceed
the cost of window(s) installed.
The following Energy Star® windows have
been installed:
_______ x $15 per opening = $________
Total Energy Star Window
Rebate Amount Requested:
ENERGY AUDIT AND
ASSESSMENT IMPLEMENTATION INCENTIVES
4 Audit must be arranged through Heartland Power Cooperative.
4 Ag and C&I audits must be performed by a Professional Engineer (PE)
or Certified Energy Manager (CEM).
4 Residential audits must be performed by a Certified Home
Performance Auditor.
4 Projects implemented must be related to electrical reduction/electrical
energy efficiency.
4 Incentive limited to the amount paid for the audit/assessment and not
to exceed the cost of the measures implemented.
4 Submit rebate form with a copy of your invoice for the audit or
assessment and a copy of your invoice for the energy efficiency
measures implemented.
Implementation incentive for energy audit
_______________
$______ Up to $250
Implementation incentive for energy assessment $______ Up to $150
Office use only
c Approved
c Not Approved – Reason ______________________________________
Total rebate issued $__________________________________________________________
I certify that the rebate payments requested were purchased and/or installed after December 31, 2011 and before January 1, 2013.
Cooperative representative:____________________________________________________ Date______________________________