HEATING AND COOLING – HEAT PUMPS
2016 IOWA FOR YOUR HOME REBATE APPLICATION FORM
Instructions: Fill out form completely and sign. Attach supporting documentation: itemized invoice(s), EnergyGuide label(s), if applicable, etc.
Failure to complete the form and provide documentation could result in claim being delayed, returned or denied.
Equipment must be purchased and installed between Jan. 1, 2016, and Dec. 31, 2016. Rebate applications must be postmarked by
March 31, 2017, to qualify for 2016 rebates. Rebate applications for equipment/materials purchased in 2016, postmarked after
March 31, 2017, will not be eligible for rebates.
Questions about the forms or need assistance with the forms? Call our energy efficiency representatives at 800-894-9599.
Customer Information
Name on account
Mailing address (if different from installation address)
Installation address
City
City
State
ZIP
q Replacement
ZIP
Phone
MidAmerican Energy Company account number (found on bill; first seven digits only)
This new equipment is for:
State
Email address
q New installation
q New construction
Air-Source Heat Pump Information
Must be SAVE certified (excellent rating) and meet either qualifying efficiency level; units <65 MBtu; AHRI Certified® (coil and condenser must match). Provide furnace information if the
furnace increases efficiency of heat pump. Ductless minisplit systems are eligible for rebates. The rebates will be $300 lower than indicated and the units will not be required to
be SAVE certified.
AHRI reference number
Date installed
SAVE score
Furnace model number (if applicable)
Installed cost $
SEER
HSPF
Outdoor unit manufacturer
Outdoor unit model number
Outdoor unit serial number
Indoor unit manufacturer
Indoor unit model number
Indoor unit serial number
SAVE Rebate
Cooling (SEER) Rebate
+
q $300
q SEER 15-15.9 = $550
q SEER 16 and above = $750
Heating (HSPF) Rebate
+
q HSPF 8.5-8.9 = $25
q HSPF 9 and above = $50
Total Rebate (cooling plus heating rebates)
=
Ground-Source Heat Pump Information
Must be SAVE certified (excellent rating) and meet either qualifying efficiency level; must be AHRI Certified; cooling capacity <65 MBtu. Documentation of capacities must be included
in addition to ENERGY STAR certification. The capacity and efficiency rating will be determined using the full heating load and partial cooling load for multistage equipment.
Date installed
AHRI reference number
Voltage: if dual voltage
Manufacturer
Heating capacity MBtu and COP – full
Model number
q Open loop
q Closed loop
Serial number
q Ground loop
SAVE score
SAVE Rebate
q $300
q Water loop
q Ground water
Cooling (EER) Rebate
+
+
q COP 3-3.9 = $200
q COP 4-4.9 = $400
q COP 5 and above = $600
q Water to air
q Brine to air
q Water to water q Brine to water
Installed cost
$
Heating (COP) Rebate
q EER 14-17.9 = $1,200
q EER 18-22.9 = $1,800
q EER 23 and above = $2,400
Cooling capacity MBtu and EER – partial
Total Rebate (cooling plus heating rebates)
=
Heat Pump Water Heater Information
For residential electric-only customers; not available to natural gas customers
Rebates: q EF 2-2.29 = $300
Date installed
q EF 2.3 and above = $400
Manufacturer
Model number
Capacity (gallons)
Serial number
Installed cost $
REMEMBER TO SIGN THE NEXT PAGE
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Specific Terms and Conditions
nnParticipants must be residential customers located in MidAmerican Energy Company’s Iowa service territory.
nnMidAmerican Energy Company must provide the primary electricity to the equipment for which the rebate is being paid.
nnIn order to receive an HVAC equipment rebate, the equipment must be pre-enrolled and tested by an HVAC SAVE certified
technician unless otherwise noted.
nnHeating, cooling and water-heating equipment (except ground-source heat pump) rebates are included in the comprehensive Residential
New Construction rebate and not eligible for additional separate rebates.
nnAllow 4 – 6 weeks for rebate processing.
General Qualifications and Conditions
Important: Before completing and signing this form, please read the General Qualifications and Conditions located in the 2016 For Your Home rebate booklet
or at www.midamericanenergy.com/ee.
Disclaimer
MidAmerican Energy Company does not guarantee that installation and operation of high-efficiency equipment will result in reduced usage or in cost savings.
MidAmerican Energy Company makes no warranties, expressed or implied, with respect to any equipment purchased or installed, including, but not limited to,
any warranty of merchantability or fitness for a particular purpose. In no event shall MidAmerican Energy Company be held liable for any incidental or consequential
damages or injuries resulting from defective equipment or installation. MidAmerican Energy Company reserves the right to cancel or change these programs at any time.
MidAmerican Energy Company’s acceptance of this application does not guarantee payment of rebate.
Customer Agreement
I certify that I have purchased the equipment described on this form and that it has been installed at the service address indicated. I agree to the terms and conditions associated with
this form. I understand that MidAmerican Energy Company reserves the right to inspect and verify installation before and after issuing payment.
q I also authorize the rebate check to be payable to (name – please print) __________________________________________________________________________________ instead of the name on account.
Alternate payee address __________________________________________________________________________________________________________________________________________________________________
City _________________________________________________________________________________
State _________________________________________________________ ZIP__________________________________
Customer signature
Self-installed
Date
q YES q NO
Installing Dealer Information
Dealer name
Phone
Address
Fax
City
State
ZIP
Contact name
Email address
SAVE certified technician
Date of SAVE verification
Email address
Dealer Agreement
I certify that all equipment and installation information provided on this application is correct and accurate.
Installer/dealer signature
Date
Before you submit your form:
ooFill out this form completely.
ooAttach a copy of the itemized sales receipt or invoice.
ooInclude documentation listed in the instructions.
»»Include ARI/ISO-standard specification sheets.
»»Include documentation of GSHP capacities in addition to
ENERGY STAR listing.
Send completed forms to:
Mail:MidAmerican Energy Company
P.O. Box 4628
Des Moines, IA 50305-4628
Fax: 515-244-8825
Email:rebateapplications@midamerican.com
ooSign the Customer Agreement section. If a dealer installed
the equipment, the dealer must sign the
Dealer Agreement.
For more information call 800-894-9599 or go to www.midamericanenergy.com/ee.
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