2016 ENERGY STAR® Residential Heat Pump
Equipment Rebate
*Limited Funding.
Please read the program requirements on the reverse side before completing this form.
CUSTOMER INFORMATION
First Name (please print)
Last Name
Address (where equipment was installed)
City
State
Zip Code
Mailing Address (if different from above)
City
State
Zip Code
Telephone Number
E-mail Address
Electric Account Number (where equipment was installed)
Existing heating system fuel type:
Oil
Propane
Existing domestic water heating system fuel type:
Oil
Propane
Is the Heat Pump replacing existing air conditioning units?
Yes
Electric
Other (please specify)
New Construction
Electric
Other (please specify)
New Construction
No
If yes, the capacity of the AC system being replaced is ___________BtU’s.
CONTRACTOR INFORMATION
Contractor Name
Telephone Number
Address
Fax Number
City
State
Zip Code
E-mail Address
EQUIPMENT INFORMATION
ENERGY STAR® Heat Pump/Mini-Split Systems
Manufacturer/Brand
Central/ Hybrid Air Source Heat Pump
Outdoor Model Number
Total Cost $
Rebate $
Geothermal
Ductless Mini-Split (heat pump)
Install Date
AHRI Ref #
SEER
EER
HSPF
Geothermal
COP
Indoor Model Number
ENERGY STAR® Water Heater
Equipment
Electric Heat Pump
EF
Install Date
Tank Size
# Gallons
Manufacturer/Brand
Model Number
Total Cost $
Rebate $
Total Cost $
Rebate $
> 2.3
Heating Controls
Sign Here
Equipment
WI-FI Thermostat (for Heat Pumps
Only)**
Install Date
Manufacturer/Brand
Model Number
Quantity
I have read and understand the terms and conditions on the reverse side of Application Checklist
this application. I certify that the information I have provided is true and  Attach copies of dated invoices with equipment make and model specifications.
correct and the products(s) and equipment for which I am requesting an
 Complete all questions, read terms/conditions, sign form & keep a copy.
incentive meets the requirements in this application.
 Include a recent electric bill.
___________________________________________________________  Mail completed, signed application & all documentation to:
NH Electric Co-op 579 Tenney Mountain Highway, Plymouth, NH 03264
Customer Signature
Date
Attn. Chris Johnson johnsonc@nhec.com (603) 536-8672
PLEASE REMEMBER TO READ AND COMPLETE THE NECESSARY INFORMATION ON PAGE TWO
Qualifying equipment must be installed between January 1, 2016 - December 31, 2016
NHESHVAC 01/15 rev1
TERMS AND CONDITIONS
Application Offer: This program covers products purchased and installed on or after
January 1, 2016. Details of this program, including incentive levels, are subject to change
or cancellation without notice. Applications with required documentation must be
postmarked within 30 days of installation. Funding is limited and will be available on a first
come, first serve basis for complete applications until December 31, 2016 or until all funds
have been expended, whichever occurs first. All equipment must be ENERGY STAR
Certified to be eligible for the rebate.
Eligibility: Incentives are available to all New Hampshire Electric Cooperative (NHEC)
residential customers purchasing new heat pump heating or water heating equipment for
a new or existing residence. Businesses, non-profit and governmental organizations are
not eligible. The program encourages installation be completed by a licensed contractor.
All products must meet the eligible equipment requirements. Participants who receive
equipment incentives through another energy efficiency program offered by NHEC are not
eligible to receive incentives through this program for the same equipment.
Proof of Purchase: An invoice itemizing the purchased equipment and a copy of a recent
electric utility bill must accompany each incentive application. The contractor's invoice
copy must indicate the address where the equipment was installed, equipment type, make
and model numbers and date of installation.
Application: This application must be filled out completely. The Customer must sign the
application. Submitted applications must be accompanied by the invoice and a copy of a
recent electric utility bill.
Payment: Please allow up to 45 days for payment. Payment processing may take longer
if information is missing on the application or if the equipment invoice or electric utility bill
is not included.
Endorsement: The Rebate Provider does not endorse any particular manufacturer,
contractor, vendor, product, retailer, system design or claim in promoting this program.
Approval, Verification, and Inspection: This program is being administered by
NHEC (Rebate Provider). The Rebate Provider reserves the right to verify sales
transactions and to have reasonable access to your residence to inspect the system
installed under this Program. The customer/contractor shall verify that the installed
energy-saving measures meet all applicable building codes; zoning laws, local, state,
and federal requirements; and other relevant requirements. The customer/contractor
is responsible for any applicable permits as required by aforementioned code/law.
Applicants agree to retain all records associated with this application for at least 3
years after the purchase date.
Limitation of Liability: The Rebate Provider is limited to paying the rebate incentive
specified; Rebate Providers are not liable for any consequential or incidental damages,
or for any damages in tort connected with or resulting from participation in this program.
Owner’s Certification: Owner certifies that he/she has purchased and installed the
equipment listed on the other side of this Application at the defined location. Owner
agrees that all information is true and that he/she has conformed to all program and
equipment requirements listed.
Warranties: THE REBATE PROVIDER DOES NOT WARRANT THE
PERFORMANCE OF INSTALLED EQUIPMENT, EXPRESSLY OR IMPLICITLY, and
makes no warranties or representations of any kind, whether statutory, expressed, or
implied, including without limitations, warranties of merchantability or fitness for
particular purpose regarding equipment or services provided by a manufacturer,
contractor or vendor. Contact your Contractor for details regarding equipment
performance and warranties.
ELIGIBLE EQUIPMENT & INCENTIVES – LIMITED FUNDING VISIT www.nhec.com
Only ENERGY STAR® Certified heat pumps and heat pump water heaters meeting the minimum efficiency ratings outlined in the
incentives table below will be eligible for a rebate.
ENERGY STAR qualified Heat Pumps can be found at http://www.ceedirectory.org/site/1/Home . SEER, EER, HSPF ratings can
be found at either Consortium for Energy Efficiency (ceehvacdirectory.org) or the AHRI directory (ahridirectory.org).
New For 2016 – 2% APR Financing available for Qualified Heat Pump Heating & Water Heating systems
installed in 2016. If interested submit application, HVAC Contractor Proposal and check this box 
HEATING/COOLING
Air Source Heat Pumps
Maximum Rebate – 5 tons
Geothermal Heat Pumps
Maximum Rebate – 5 Tons
Requires Pre-Approval
Whole House Incentive – for
Heat Pump Systems offsetting
80% of total heating load
Weatherization Incentive - for
participating in the Home
Performance w/ Energy Star
program - (must install all cost
effective shell measures and
all health and safety
recommendations during 2016
program year)
REBATE
AMOUNT
SEER
EER
HSPF
$250/ton*
≥ 15
≥ 12.5
≥ 8.5
≥ 18
≥ 12.5
≥ 10
$500/ton*
$500/ton*
≥ 16
COP
HEATING CONTROLS
REBATE
AMOUNT
WI-FI Thermostat**
$100
$250/ton*
Only available for heat
pumps also receiving a
rebate.
≥ 3.0
WATER HEATING
$250/ton*
ELECTRIC
EF
Must submit two (2) years heating
fuel usage, type and efficiency of
existing equipment.
Please submit application from HHI
link below and circle this box if
applying for this bonus incentive.
REBATE
AMOUNT
$500/50
gal.
≥ 2.3
$600/80
gal.
≥ 2.3
Heat Pump Water Heater
*Tonnage calculated by dividing rated Cooling Btu’s by 12,000, (i.e. 40,000 Btu’s cooling / 12,000 = 3.33 tons. 3.33 tons x $/ton = rebate)
**WI-FI connections must be enabled. Rebate not to exceed purchase price. Limit two (2) per account
Qualifying equipment must be installed between January 1, 2016 – December 31, 2016 to be eligible for a rebate.
Owner/Contractor may be required to provide documentation that equipment meets program guidelines.
Owners should verify with contractor that electrical service and service entrance will meet loads of new equipment.
Applicants are required to complete a Home Heating Index (HHI) from the Home Performance w/ Energy Star
Program (Does not apply to new construction):
http://hhi.nhsaves.com/homeheating/Default.aspx HHI Number ________