6.1d1 EMRUSR 08-13-2024• Air Source Heat Pump Tune Up
• Central and Ductless Heat Pumps
• Cold Climate Heat Pumps�,Q xs
• Ground Source Heat Pumps
• Heat Pump Water HeaterJ,
See back for details regarding specific rebate requirements.
Take advantage of ERMU's heat pump rebates for on -the -spot savings and year-round comfort. Consider the sustainability of a heat
pump when upgrading your home's heating and cooling system and experience reduced energy usage with increased savings.
How to Receive a Rebate
(Valid for customers of Elk River Municipal Utilities only. Rebates come in the form of bill credit.)
1 Complete the front and back of this rebate form. 4 Mail or bring to
2 Include a copy of the original itemized sales receipt Elk River Municipal Utilities
and/or invoice for each qualifying product. ATTN Rebate Program
3 Include a copy of the AHRI Certificate of Product Ratings. 13069 Orono Pkwy NW, Elk River, MN 55330
This document can be provided by your contractor. OR Email customerserviceC ermumn.com
CUSTOMER INFORMATION (please complete all information below)
Name Phone County
Install Address City State Zip
Email Account #
Building Type (select one) ❑ Single Family ❑ Multi Family
Email Address
OR
SCAN HERE
to submit
documents
online.
RETAILER /CONTRACTOR /INSTALLER INFORMATION
Company Name Phone
Mailing Address City
CERTIFICATIONS AND SIGNATURE
I hereby certify that
• The information contained in this application is accurate and complete.
• All installation is complete, and the unit(s) is operational prior to submitting application.
• All rules of this rebate program have been followed.
I agree to verification of equipment installation which may include a site inspection by a program or utility representative. I understand that I
am not allowed to receive more than one rebate from this program on any piece of equipment. I agree to indemnify, defend, hold harmless
and release ERMU from any claims, damages, liabilities, costs and expenses (including reasonable attorney's fees) arising from or relating
to the removal, disposal, installation or operation of any equipment or related materials in connection with the programs described in this
application, including any incidental, special or consequential damages.
ERMU reserves the right to reject any rebate application submitted as a result of work performed by a contractor who has failed to adhere
to the terms and conditions established for the rebate program.
Homeowner Signature Print Name Date
Elk River M
Municipal Utilities MR.My MI.
HEAT PUMPS
RESIDENTIAL REBATE APPLICATION
AIR SOURCE HEAT PUMP TUNE UP REBATE: Up to $75 / UNIT
(Must provide professional contractor invoice showing tune up activity performed)
Quantity Cooling Capacity (Tons) Unit Efficiency: SEER EER
Completed (check all that apply) ❑ Condenser Coil Cleaning & Filter Change ❑ Refrigerant Charge Correction & Air Flow Correction
Contractor Name Date of Service
CENTRAL AND DUCTLESS HEAT PUMPS
(Units 15.2 SEER2 & 7.8 HSPF2 or higher will qualify. Must be ENERGY STAR°certified)
Quantity Cooling Capacity (BTU/hour) Heating Capacity (BTU/hour) .
SEER2 EER2 HSPF2
Manufacturer Name Model Number Date of Install
REBATE: $400 / UNIT
COLD CLIMATE HEAT PUMPS REBATE: $1,000 / UNIT
(Minimum 15.2 SEER2, 8.1 HSPF2, & COP >=1.75 at 5°F. Must be ENERGY STARecertified)
'Must meet Northeast Energy Efficiency Partnership (NEEP) efficiency specifications for cold climate models
Quantity Cooling Capacity (BTU/hour)
SEER2 HSPF2
If the old system had a furnace, enter furnace capacity (BTU/hour) —
Manufacturer Name Model Number
GROUND SOURCE HEAT PUMPS
(Closed -loop system only. Must be ENERGY STAR®certified)
Cooling Capacity (BTU/hour)
FFP
Manufacturer Name
Heating Capacity (BTU/hour)
Heating Capacity (BTU/hour)
C'nP
Model Number
HEAT PUMP WATER HEATER
(Must have UEF of 2 or higher. Must be ENERGY STAR°certified)
Quantitv
Uniform Energy Factor (UEF)
Space Heating Type (select one) ❑ Electric
Manufacturer Name
Date of Install
REBATE: $600 / TON
Date of Install
REBATE: $400 / UNIT 50-79 gallon 1 $450 / UNIT < 80 gallon
New Unit Tank Size (gallons)
If greater than 55 gallons must be greater than 2.2
❑ Gas Style
Model Number
Date of Install
106