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1/2013 Page 1
MEMBER INFORMATION
HVAC REBATE PROGRAM APPLICATION
As shown on PEC Bill
First Name: ___________________________________ Last Name: __________________________________________________
PEC Account #: ________________________________________
Installation Street Address: ___________________________________________________________________________________
City: ______________________________________________________ State: ______________Zip: _________________________
County: ___________________________________________________
PO Box/Mailing Street Address: _______________________________________________________________________________
City: ______________________________________________________ State: ______________Zip: _________________________
Primary Phone #: __________________________________ Secondary Phone #: _______________________________________
Email: ______________________________________________________________________________________________________
Sqft. of Home: ____________________ Age of Home (Years): ______________ Installation Date: _________________________
All required documents must be received within 60 days of installation.
Is this a landlord account? Is this a rental property?
CONTRACTOR INFORMATIONCompany Name: _____________________________________________________________________________________________
Contact Name: ______________________________________________________________________________________________
TALC #: _______________________________________________ Phone #: _____________________________________________
Fax #: ____________________________________________ Email: __________________________________________________
EQUIPMENT INFORMATIONNEW UNIT 1:
AHRI Reference #: _________________________________________________
AFUE Rating: ______________________________________________________ Required for Gas Furnace (If AFUE Rating is not on your AHRI Certificate, contact your contractor for this information)
Condenser Model # / Ground Source HP #: ___________________________
Condenser Serial #: ________________________________________________
Evaporator Model #:________________________________________________
REPLACED UNIT 1:
A/C with Gas Furnace Heat Pump Ground Source A/C with Electric Furnace
Evaporator Serial #: ________________________________________________
SEER: ____________ EER: ______________BTUH: ______________________
HSPF: ____________________________Tons: ___________________________Program guidelines minimum HSPF is 8.2
Fields below are for Ground Source Heat Pump units only
COP: _____________ Check this box if this unit has a desuperheater?Program guidelines minimum COP is 3.1
Age of Unit: __________________________________SEER: _______________________________________ EER: ________________________________________
A/C with Gas Furnace A/C with Electric Furnace Heat Pump Ground Source Mini -Split A/C Mini-Split Heat Pump
1/2013 Page 2
HVAC REBATE PROGRAM APPLICATION CONTINUED
APPLICANT ACKNOWLEDGEMENT
By signing this form, the Member affirms that the information reflected here is accurate to the best of his or her knowledge and that falsification or reporting of incorrect information on this form is grounds for denial of the rebate.
Member Signature: __________________________________________________________________________________________
AHRI CERTIFICATE WITH A SIGNED AND DATED INVOICE
INCLUDING COST OF THE UNIT MUST ACCOMPANY THIS APPLICATION.
MAIL TO: Pedernales Electric Cooperative, Inc. HVAC Rebate Program P.O. Box 1Johnson City, TX 78636
FAX TO: (512) 533-0777E-MAIL TO: [email protected]
EQUIPMENT INFORMATIONNEW UNIT 2:
AHRI Reference #: _________________________________________________
AFUE Rating: ______________________________________________________ Required for Gas Furnace (If AFUE Rating is not on your AHRI Certificate, contact your contractor for this information)
Condenser Model # / Ground Source HP #: ___________________________
Condenser Serial #: ________________________________________________
Evaporator Model #:________________________________________________
REPLACED UNIT 1:
A/C with Gas Furnace Heat Pump Ground Source A/C with Electric Furnace
Evaporator Serial #: ________________________________________________
SEER: ____________ EER: ______________BTUH: ______________________
HSPF: ____________________________Tons: ___________________________Program guidelines minimum HSPF is 8.2
Fields below are for Ground Source Heat Pump units only
COP: _____________ Check this box if this unit has a desuperheater?Program guidelines minimum COP is 3.1
Age of Unit: __________________________________SEER: _______________________________________ EER: ________________________________________
A/C with Gas Furnace A/C with Electric Furnace Heat Pump Ground Source Mini -Split A/C Mini-Split Heat Pump