RESIDENTIAL HEATING SYSTEM WITH PROGRAMMABLE THERMOSTAT …€¦ ·  · 2016-01-06New home construction. Type of ... For rebate to apply the new equipment must be listed and AFUE

If different from above, name, address and city where new heating system is installed

Type of buildingPurchaser type Owner BuilderLandlordRenter Agency TownhomeSingle-family Two-plex to four-plex

Replacement (includes additions / remodel)New home construction

Type of installation

DateX Purchaser's signature

Purchaser's Email address (for questions on rebate paperwork)

CenterPoint Energy acct# where new heating system is installed

City / State / ZipMailing address

Home phoneDaytime phonePurchaser's name

PURCHASER INFORMATION (CenterPoint Energy Minnesota natural gas customers - please print.)

Program dates: Jan. 1, 2016 through Dec. 31, 2016

Please complete one form per heating system purchased and installed. Rebates must be submitted in the calendar year of installation.

To receive your rebate, please submit all requested information, including a detailed copy of the dated sales invoice from your heating dealer and all requested signatures. Please see other side for program guidelines.

COMPLETION OF ALL FIELDS IS REQUIRED FOR PAYMENT

It is the responsibility of the dealer and the purchaser to ensure that the program requirements are met. If program requirements are not met, no rebate will be paid. *CenterPoint Energy assigns six-digit Dealer ID numbers to participating dealers. If ID number is not assigned, rebate can be submitted and dealer should contact us to acquire one.

EQUIPMENT INFORMATION (To be completed by heating dealer - please print.) See reverse side for rebate amounts.

Heating system (select one) Forced air furnace Natural gas boiler

New programmable thermostat: (when dealer installs with qualifying heating system - review back of application for eligibility)

Serial # 2016 Date of installation

Manufacturer model numberBrand

AFUE %

Complete model #Brand BTU/hr input

DEALER INFORMATION (To be completed by heating dealer - please print.)

Dealer phoneCompany Name Dealer ID*

DateX Dealer or installer signature

City / State / ZipAddress

Dealer Email address

CNP 1011 (1-2016)

RESIDENTIAL HEATING SYSTEM WITH PROGRAMMABLE THERMOSTAT REBATE MINNESOTA

Return completed form with required signatures and a detailed copy of dated sales invoice to:

CenterPoint Energy Heating System Rebate PO Box 59038 Minneapolis, MN 55459-0038

Rebate contact name

RESIDENTIAL HIGH EFFICIENCY HEATING SYSTEM WITH PROGRAMMABLE THERMOSTAT REBATE

GUIDELINES The qualifying equipment must be installed in a Minnesota home served with natural gas from CenterPoint Energy between January 1 and December 31, 2016. All completed applications must be postmarked by December 31, 2016 to be considered for a rebate.

Heating dealers are not eligible to receive their customer's rebate. Building contractors should negotiate with homeowners to determine who receives the rebate. Equipment installed under warranty replacement does not qualify for the rebate. CenterPoint Energy reserves the right to inspect the installed equipment.

NOTE: For rebate to apply the new equipment must be listed and AFUE verified on the current Air Conditioning, Heating and Refrigeration Institute (AHRI) or ENERGY STAR website. See: ahridirectory.org or energystar.gov

APPLICATION CenterPoint Energy cannot process a rebate without all the requested information on the rebate form and invoice. Work with your heating dealer to complete the entire rebate application and obtain a dated sales invoice showing the detail of what was purchased and installed.

The purchaser of the heating system and a representative from your retail heating dealer are required to sign the rebate application.

ATTACH PROOF OF PURCHASE AND INSTALLATION Required information on dated sales invoice includes: Purchaser name, installation address, brand of heating system, complete model number and seral number of heating system. We also need the manufacturer brand and model number of new programmable thermostat and the dealer company name and address.

HELP WITH FORMS If you have questions filling out this form, please contact your heating dealer for assistance.

If your are building a home, you must obtain an invoice from your builder or heating dealer. Only one rebate per piece of equipment. PROCESSING Completed rebate forms will be processed in the order in which they are received and are paid on a first-come, first served basis. Account number must be activated for installation address in order for rebate to be processed. CenterPoint Energy is not responsible if the dealer does not provide accurate information about the amount of a rebate or equipment eligibility. Rebate qualifications and amounts are subject to change. CenterPoint Energy Conservation Improvement Program (CIP) rebate programs may be cancelled or changed at any time. CenterPoint Energy issues a cash rebate not utility bill credits. Please allow 8 weeks to receive payment in the mail from the time that CenterPoint Energy receives your completed paperwork. If you have not received payment after this time, call 612-399-1545 or email [email protected]

APPLICATION CHECKLIST SEND COMPLETED APPLICATION TO: □ All fields on form completed Heating System Rebate □ Purchaser signature CenterPoint Energy □ Dealer signature PO Box 59038 □ Dated detailed sales invoice from heating dealer Minneapolis, MN 55459-0038

$300 Natural gas boiler 83.5-90.9%91% or higherNatural gas boiler$500

96% or higher$400 Forced air furnace (replacement)

95% or higher$350 Forced air furnace (new construction)92-94.9%$50 Forced air furnace (new construction)

94-95.9%92-93.9%

$300 Forced air furnace (replacement)$150 Forced air furnace (replacement)

$25$25

$25

Not eligibleNot eligible

$25$25

Heating Rebate Type of natural gas heating system AFUE rating on current AHRI or ENERGY STAR website

Receive an additional $25 rebate when your dealer installs a new programmable thermostat with a qualifying heating system installation