Fillable Form 2021: (Mass Save)

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Form 2021: (Mass Save)

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2021
Residential air to water
heat pump rebate form
WE ARE MASS SAVE®:
1
Actual tons are calculated based on MassSave.com/HPQPL. Cooling capacity divided by 12,000 BTUs. Rebate amount based on actual tons.
NEXT STEPS
1. Work with a licensed HVAC contractor to determine if air to water heat pumps are right for your home.
Before installation, consider the following:
Use with your existing boiler distribution system
Using air to water heat pumps in the winter to complement your existing heating system can reduce your overall heating
costs without sacrificing comfort. The highest cost savings occur when air to water heat pumps serve as the primary
source of heat for an entire zone currently heated by oil or propane heating system.
For more information visit MassSave.com/HPQPL
2. Interested in 0% financing?
Apply for a Mass Save HEAT Loan prior to installing your equipment. Learn more at MassSave.com/HEATLoan
3. Oers valid only for residential electric customers in MA where the Mass Save Electric Heating and Cooling
Program is oered by Cape Light Compact, Eversource, National Grid and Unitil.
4. Upon completion of installation, apply for a rebate by submitting all required documentation online at
MassSave.com/Rebates or by mail to Mass Save Residential Heating & Cooling Program, P.O. Box 2528,
Manchester, CT 06045
FUEL OPTIMIZATION AIR TO WATER HEAT PUMP REBATES
Equipment Type
Eciency
Requirements
Primary Fuel Type Rebate Amount
1
Air to Water
Heat Pump
Refer to Air to Water Heat Pump
Qualified Products List at
MassSave.com/HPQPL
Oil or Propane $1,250 per ton
2021 residential air to water heat pump rebates
Save with rebates on air to water heat pump equipment installed between January 1, 2021 and December 31, 2021.
Rebate not to exceed purchase price. Limit five (5) outdoor condensing units per electric meter.
FOR ADDITIONAL INFORMATION, VISIT MASSSAVE.COM/REBATES OR CALL 800-232-0672.FOR ADDITIONAL INFORMATION, VISIT MASSSAVE.COM/REBATES OR CALL 800-232-0672.
WE ARE MASS SAVE®:
2021 residential air to water heat pump rebate form
New Air to Water Heat Pump Equipment Installed (CANNOT APPLY FOR MULTIPLE REBATE OFFERS FOR SAME EQUIPMENT INSTALLATION)
Rebate Type
Rebate Amt.
Install Date Condenser Model Number
# of Tons
(1 Ton =
12,000 BTUs)
Customer
Rebate
(Rebate Amt. x
# of Tons)
Air to Water Heat Pump
$1,250 per ton
1. To receive your rebate faster, submit online at MassSave.com/Rebates
2. By mail, send all required documentation to Mass Save Residential Heating & Cooling Program, P.O. Box 2528, Manchester, CT 06045
REQUIRED DOCUMENTS*
1. *Completed and signed application. 2. *Copy of your most recent electric utility bill. 3. *Contractor’s invoice including:
❍ *Equipment Make ❍ *Condenser and Indoor Unit Model Numbers ❍ *Size in Tons ❍ *Installation Date and Address ❍ *Total Install Cost and Proof of Payment
❍ *Contractor Information ❍ Fuel Optimization rebates only: *A copy of your most recent oil or propane bill and Manual J.
Residential Electric Utility or Energy Eciency Provider:* Cape Light Compact Eversource National Grid Unitil
Account Holder Name:*
Electric Account Number:* Do you own or rent your home? Own
Rent
Installation Address:* City:* State:* ZIP Code:*
(must match the residential electric account address)
Phone Number: Email:
Customer Signature: Date:
I certify that all information is correct to the best of my knowledge and that I adhere to all terms and conditions of this rebate.
CUSTOMER INFORMATION (FILL CIRCLES COMPLETELY)
MA
MAILING ADDRESS FOR REBATE (IF DIFFERENT FROM ABOVE)
Payee Name: Phone Number: Email:
Address: City: State: ZIP Code:
Pre-Existing Fuel Type:
Oil Propane None
AWHP TABLE
FOR ADDITIONAL INFORMATION, VISIT MASSSAVE.COM/REBATES OR CALL 800-232-0672.
*Required Fields/Documents
CONTRACTOR INFORMATION
Note: All contractor information contained in this section is required on the contractor’s invoice.
Company Name:* Contact Person:*
City:* State:* ZIP Code:*
Phone Number:* Email:*
Please allow 6–8 weeks for processing. For more information, to confirm eligibility or to check the status of your rebate,
call 800-232-0672 or email ask@efi.org
click to sign
signature
click to edit
TERMS AND CONDITIONS
Equipment Requirements
Air to water units must be listed on the air to water heat pump qualified
product list.
One ton is equal to 12,000 BTU/h. Rounding up is not acceptable.
General Requirements
Application Form: This application must be filled out completely, truthfully,
and accurately. The customer must date and submit the completed application
along with all required documentation for specific rebates and/or incentives.
By submitting the rebate application, the customer agrees to abide by these
Terms and Conditions.
Time Limit: Qualifying units for equipment rebate must be purchased and
installed between January 1, 2021 and December 31, 2021. Applications must be
postmarked by January 31, 2022. Program is subject to change without prior
notice, including rebates and incentive levels.
Payments: From the time the application is processed and approved,
please allow 6–8 weeks for payment. Payment processing will take longer
if information or documentation is missing from the application. If payee
information is dierent from account holder information and the electric utility
provider is National Grid, additional processing time will be needed for payee
verification.
Geographic Requirements: Oers valid only for residential electric customers
in MA where the Mass Save Heating and Cooling Program is oered by Cape
Light Compact, Eversource, National Grid and Unitil.
Rebate Limitations: This rebate may not be combined with any other utility
or energy eciency service provider oer for the same equipment. This does
not apply to the HEAT Loan financing program. Other, non-Mass Save rebates
or incentives may also be used. Rebate amount not to exceed the cost of
equipment (excluding sales tax and all installation costs) and may be subject to
change without notice.
Proof of Purchase: A copy of the customer’s invoice itemizing the purchased
equipment must accompany each rebate application form. The invoice must
indicate the equipment make, condenser and indoor unit model numbers, size
in tons, installation date and address, total install cost and proof of payment.
Contractor Certification: Contractor certifies that installation and services
performed have been in accordance with all applicable municipal, state and
federal codes, standards and regulations, as well as program requirements
pertaining to the installed system.
Approval and Verification: The participating utility or energy eciency service
provider reserves the right to conduct field inspections to verify installations.
Tax Liability: Sponsors will not be responsible for any tax liability that may be
imposed on the customer or contractor as a result of the payment of rebates.
Endorsement: Sponsors do not endorse any particular manufacturer, product,
system design, or technology in promoting these oers.
Limitation of Liability: Sponsors and their rebate administrator’s liability is
limited to paying the rebate and incentive specified. Sponsors and their rebate
administrator are not liable for any consequential or incidental damages or for
any damages in tort connected with or resulting from participation in these
oers.
Warranties: SPONSORS DO NOT WARRANT THE PERFORMANCE OF
INSTALLED OR SERVICED EQUIPMENT, EXPRESSLY OR IMPLICITLY. Program
sponsors make no warranties or representations of any kind, whether
statutory, expressed, or implied, including, without limitations, warranties or
merchantability or fitness for a particular purpose regarding the equipment or
services provided by a manufacturer or vendor. Contact your contractor for
details regarding equipment performance and warranties.
Electric Benefits: Other than the energy cost savings realized by customer, the
program administrator is entitled to 100% of the benefits and rights associated
with the energy-ecient measures, including without limitation ISO-NE
products and all other attributes, credits or products associated therewith
under any regional initiative or federal, state or local law, program or regulation
or program, and customer waives, and agrees not to seek, any right to the
same.
FOR ADDITIONAL INFORMATION, VISIT MASSSAVE.COM/REBATES OR CALL 800-232-0672.
WE ARE MASS SAVE®:
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Completed 22 July 2021

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