6.1d2 EMRUSR 08-13-2024• Central AC
• Central AC Tune Up
• Mini Split Ductless Air Conditioner
• Air Conditioner Room Unit/Window AC
�� • Replacement Furnace with ECM Blower Motor
i l • ECM Circulators
• Thermostats (Programmable and WiFi)
See back for details regarding specific rebate requirements.
Over half of the energy used in your home goes to heating and cooling, so when the time comes to update your HVAC equipment,
ERMU makes it easy to make the smart choice. Residential electric customers can receive rebates in the form of credits on their
utility bills now and enjoy reduced energy costs for years to come.
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 OR C
2 Include a copy of the original itemized sales receipt Elk River Municipal Utilities SCAN HERE I.
and/or invoice for each qualifying product. ATTN Rebate Program to submit
3 Include a copy of the AHRI Certificate of Product Ratings. 13069 Orono Pkwy NW, Elk River, MN 55330 documents
This document can be provided by your contractor. OR Email customerservice@aermumn.com online.
CUSTOMER INFORMATION (please complete all information below)
Name Phone County
Install Address City State Zip
Email
Building Type (select one) ❑ Single Family ❑ Multi Family
Account #
RETAILER / CONTRACTOR / INSTALLER INFORMATION
Company Name
Mailing Address
CERTIFICATIONS AND SIGNATURE
Phone
City
Email -Address
State Zip
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
E1kRiver .� M HVAC EQUIPMENT
Municipal Utilities PURIM MI, RESIDENTIAL REBATE APPLICATION
EQUIPMENTHVAC QUALIFY .. one date of installation)
CENTRAL AC (Units 15.2 SEER2 or higher will qualify. Must be ENERGY STAR" certified) REBATE: $125 / UNIT
Quantity
NEW UNIT EFFICIENCY I SEER2
Manufacturer Name
Cooling Capacity (BTU/hour)
EER2
Model Number
Date of Install
CENTRAL AC 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
MINI SPLIT DUCTLESS AIR CONDITIONER REBATE: $150 / UNIT
(Units 15.2 SEER2 or higher will qualify. Must be ENERGY STAR" certified)
Quantity
Manufacturer Name
Cooling Capacity (BTU/hour)
Model Number —
SEER2
Date of Install
AIR CONDITIONER ROOM UNIT/WINDOWAC (MustbeENERGY STAR®certified) REBATE: $10/UNIT
Quantity Cooling Capacity (BTU/hour) CEER Rating
Features (select one) ❑ Reverse Cycle ❑ Louvered Style (select one) ❑ Sleeve ❑ Window
Manufacturer Name Model Number Date of Install
REPLACEMENT FURNACE WITH ECM BLOWER MOTOR (Must be ENERGY STARR certified) REBATE: $150 / UNIT
Quantity Central AC in Building (select one) ❑ Yes ❑ No
Manufacturer Name Model Number Date of Install
ECM CIRCULATOR (Must be ENERGY STAR®certified) REBATE: $100 / UNIT (Not to exceed 50% of pump cost)
Quantity Pump Wattage
Function of Pump (select one) ❑ Domestic Hot Water ❑ Space Heating Hot Water Date of Install
THERMOSTAT (Must be ENERGY STAR®certified) REBATE: $20 / UNIT (Programmable) or $40 / UNIT (WiFi compatible)
Quantity Heating Type (select one) ❑ Electric ❑ ASHP ❑ GSHP ❑ Gas
New Thermostat Type (select one) ❑ Tier 1 (Programmable) ❑ Tier 2 (Communicating - WiFi) ❑ Tier 3 (Analytics Capable - WiFi)
Manufacturer Name Model Number Date of Install
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