ductless heat pump program rebate form - Going Ductless

DUCTLESS HEAT PUMP PROGRAM REBATE FORM DHP-RBT, Rev. 10/17, Eff. 10/17

CUSTOMER / OWNER NAME

SITE ADDRESS

CONTRACTOR

CPU FINANCING? YES

DUCTLESS HEAT PUMP MEASURES

Ductless Heat Pump Single Indoor Head Minimum of 9.0 HSPF

REBATE AMOUNT

$1,000

Ductless Heat Pump Replacement/Upgrade Minimum of 11.0 HSPF

$100

utilize billing data for energy savings analysis. With this authorization, the utility may also release up to two years preinstallation and up to two years post-installation of the customer's billing information to BPA and other third parties in order to perform energy savings analysis. The customer also hereby releases the utility from any and all liability arising from or connected with the release of this information.

CUSTOMER / OWNER INITIALS* (REQUIRED)

$750

Ductless Heat Pump Multiple Indoor Heads Minimum of 8.2 HSPF (Single Family Only)

* By initialing this form, the customer authorizes the utility to

CONTRACTOR REP INITIALS

NO

SIGN OVER REBATE PAYMENT TO CONTRACTOR Customer / Owner signs over the total Clark Public Utilities rebate payment through signature below to be 'payable to' the contractor that performed the conservation measure(s) indicated above: CUSTOMER / OWNER SIGNATURE

DATE