Heat Pump/Geo Thermal Credit Claim Form

Name______Account Number______

Phone Number: (Home)______(Work)______

In consideration of receiving a $300 credit for installation of an air source or geothermal heat pump system, the undersigned cooperative member agrees to abide by all the terms and conditions of this agreement. All qualifications and minimum standards (see page 2) must be adhered to as stated within the POWERMOVES® residential HVAC program. Application for credit must be made within 60 days following the date of installation or purchase of spec home.

Type of Unit installed:_____ Air source heat pump *Check with REMC to ensure your transformer ______Geothermal heat pump is accurately sized for additional load.

The unit was installed to: ______Replace existing fossil fuel furnace ___natural gas___propane ____oil____wood ______New construction ______Replace existing non-serviceable heating/cooling system ______Replace an air conditioning unit with heat pump

Please provide the following documentation:

1. This Credit Claim Form completed and signed by member. 2. Heat loss/gain calculations including economic balance point must be performed prior to installation and be submitted with this claim form. 3. Copy of AHRI (Air-conditioning, Heating and Refrigeration Institute) certificate

Your signature on this form allows LaGrange County REMC to contact your dealer/installer and releases them from any liability for giving us information regarding your system. LaGrange County REMC shall have the option to inspect the installation of the heat pump/geothermal system.

If the requirements are not met, the credit will be void and charged back to the member if previously issued.

I have read and understand the terms and conditions for the heat pump incentive program.

Date______Member Signature______

LaGrange County REMC Representative______

Effective July 2017 Qualifications and minimum standards

Air source heat pump:

 Packaged: SEER ≥ 14; HSPF ≥ 8.  Split: SEER ≥ 15; HSPF ≥ 8.5.

Ground source heat pump:

 Closed: EER ≥ 17 COP ≥ 3.6.  Open: EER ≥ 21.1 COP ≥ 4.1.

This $300 credit is only eligible to those members that did not qualify for a rebate through the POWERMOVES® program.

Effective July 2017