2021
Residential natural gas
heating & water heating
equipment rebate form
WE ARE MASS SAVE
®
:
Visit MassSave.com/Thermostats for the most current list of qualifying thermostat manufacturers.
2021 residential natural gas heating & water heating equipment rebate form
Save with rebates on residential natural gas heating & water heating equipment installed between January 1, 2021
and December 31, 2021.
Rebate not to exceed purchase price. Limit three (3) rebates per gas meter.
HIGH-EFFICIENCY HEATING EQUIPMENT
Measure Description
Date
Installed*
Manufacturer* Model Number* QTY*
Rebate
Amount
Natural Gas Furnace w/ECM** 95% AFUE
$1,000
Natural Gas Furnace w/ECM** 97% AFUE
$1,250
Natural Gas Furnace w/ECM**
w/On-Demand DHW 97% AFUE
$950
Natural Gas Hot Water Boiler 90% AFUE
$2,000
Natural Gas Hot Water Boiler 95% AFUE $2,750
Condensing Boiler w/On-Demand DHW
95% AFUE
$2,400
** Electronically Commutated Motor
HIGH-EFFICIENCY WATER HEATING EQUIPMENT
Measure Description
Date
Installed*
Manufacturer* Model Number* QTY*
Rebate
Amount
ENERGY STAR® Certified On-Demand
Tankless Water Heater .87 UEF
$700
ENERGY STAR® Certified Storage
Water Heater Medium Draw .64 UEF
High Draw .68 UEF
$100
ENERGY STAR® Certified Condensing
Gas Water Heater .80 UEF
$500
Indirect Water Heater must be connected
to a natural gas forced hot water boiler
$400
Rebate not to exceed purchase price. Limit four (4) thermostat rebates per gas meter.
HEATING CONTROLS
Measure
Description
Date
Installed*
Manufacturer*
Model
Number*
Does your home
have a central air
cooling system?*
Installed by*
Purchase
Price
QTY*
Rebate
Amount
Programmable
Thermostat
Yes
No
Self
Contractor
$25
ENERGY STAR® Certified
Smart Thermostat
(Visit MassSave.com/Thermostats
for qualified models)
Yes
No
Self
Contractor
$100
For smart thermostats only. Customers with central A/C must provide serial number and MAC address to be eligible for additional oerings.
Serial Number: MAC Address:
WE ARE MASS SAVE
®
:
FOR ADDITIONAL INFORMATION, VISIT MASSSAVE.COM/REBATES OR CALL 800-232-0672.
2021 residential natural gas heating & water heating equipment rebate form
GET STARTED
1. Work with a licensed contractor to install a qualifying product at a property with an active residential gas heating account with Berkshire Gas,
Eversource, Liberty
, National Grid or Unitil.
2. Interested in 0% financing? Apply for a Mass Save® HEAT Loan prior to installing your equipment. Learn more at MassSave.com/HEATLoan
COMPLETE FORM AND SUBMIT REBATE
REQUIRED DOCUMENTS*
1. *Completed and signed application. 2. *Copy of your most recent gas utility bill. 3. *Copy of a dated work order, invoice, or
receipt within 60 days from installation. Invoice must include the following.
*Contractor Information *Equipment Manufacturer & Model Number *Installation Date & Address *Total Install Cost & Proof of Payment
To receive your rebate faster, submit online at MassSave.com/Rebates
By mail, send all required documentations to Mass Save Residential Heating & Cooling Program, P.O. Box 2528, Manchester, CT 06045
Note: Completed rebate application and required documentation must be submitted within 60 days of completion of work and by January 31, 2022. Rebate processing time is typically less
when submitting online.
*Required Fields/Documents
CUSTOMER INFORMATION (FILL CIRCLES COMPLETELY)
Massachusetts Residential Gas Utility:* Berkshire Gas Eversource Liberty National Grid Unitil
Account Holder Name:*
Natural Gas Account Number:* Is this property primarily occupied by the owner or a renter? Owner Renter
Installation Address:
(must match the residential gas account address)
* City:* State:*
MA
ZIP Code:*
Phone Number: Email:
CUSTOMER ACCEPTANCE OF TERMS
I hereby request a rebate for the listed work. Attached are copies of all receipts or invoices. I have read and agree to the Terms and Conditions of this form. I certify that a licensed contractor
has installed the listed high-eciency natural gas heating and/or water heating system in accordance with Program Guidelines and Terms and Conditions as described on this form. In an
eort to continuously improve our process we may contact you regarding your experience. The participating utility or energy eciency service provider reserves the right to conduct field
inspections to verify installations in accordance with proper guidelines.
Customer Signature: Date:
ELECTRIC SERVICE PROVIDER
(REQUIRED FOR SMART THERMOSTAT REBATE ONLY)
Massachusetts Residential Electric Utility or Energy Eciency Provider:* Cape Light Compact Eversource (MA Only)
National Grid Electric (MA Only) Unitil Electric (MA Only) Municipal Electric Company
Electric Account Number (Must match installation address):*
MAILING ADDRESS FOR REBATE
(IF DIFFERENT FROM ABOVE)
Payee Name: Phone Number: Email:
Address: City: State: ZIP Code:
CONTRACTOR INFORMATION
Note: All contractor information c
ontained in this section is required on the contractor’s invoice.
Company Name:* Contact Person:*
City:* S
tate:* 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
FOR ADDITIONAL INFORMATION, VISIT MASSSAVE.COM/REBATES OR CALL 800-232-0672.
click to sign
signature
click to edit
TERMS AND CONDITIONS
Customer Eligibility: You must be a residential natural gas heating customer
of Berkshire Gas, Eversource (MA Only), Liberty (MA Only), National Grid (MA
Only), or Unitil (MA Only) to qualify. Only equipment purchases
and installations made between January 1, 2021 and December 31, 2021 are
eligible for rebates. Except for thermostats, all equipment must be installed
by a licensed heating or plumbing contractor at the customer’s address listed
on the Rebate Form. All installations must conform to all applicable codes and
be installed in accordance with all rebate Program Guidelines. Rebate form
must be filled out completely, signed and accompanied by dated receipts or
invoices, and received by the program within 60 days from installation date.
By submitting the application, the customer agrees to abide by these Terms
and Conditions. Equipment installed in new construction is not eligible if
incentives have already been received through Renovations & Additions or
Residential New Construction.
Installation Verification: Prior to honoring any rebate, the program reserves
the right to conduct an on-site verification that the equipment has been
installed according to program guidelines and is in operation. This site visit, and
all aspects related to this site visit, are conducted solely for such purpose. The
site visit is not a safety review, nor is it intended for any other purpose.
When will I receive my rebate? Pending approval, we will process and mail
the rebate within 6–8 weeks of receipt of the properly completed and signed
application.
No Warranties: The program and the vendor do not endorse, guarantee or
warrant any particular contractor, manufacturer or product installation. The
program and the vendor do not make any representation of any kind regarding
the results to be achieved by the equipment or the adequacy or safety of
such equipment. The program is not responsible for any damage that may
be caused by or arise out of an installation of any equipment, whether self
installed by the customer or installed by a contractor.
Changes to High-Efficiency Equipment Rebate Program: The program is
subject to change without prior notice, and rebate oers may increase or
decrease at any time. Projects greater than ten (10) units require pre-approval
from the Program. Pre-approval can be obtained by contacting ask@efi.org.
Tax Liability: Participants of the program may be subject to tax liability for the
value of goods and services received through the program pursuant to state or
federal income tax codes.
No Tax Liability to the Program and Rebate Administrator: The program and
the rebate administrator are not responsible for any tax liability which may be
imposed as a result of receipt of the rebates provided by the natural gas utility
to the customer.
Liability & Release: As part of the consideration for participating in the
program, participant hereby releases and shall indemnify, hold harmless and
defend the program, its member utilities, and the rebate administrator from any
and all claims, losses, harm, costs, liabilities, damages and expenses (including
attorneys’ fees) of any nature whatsoever arising directly or indirectly out of or
in connection with the installation of high-eciency equipment at the premises
or any material and labor required for such installation.
Changes to Rebate Amounts: The program will provide rebates for approved
equipment up to the rebate amount indicated in this application. Maximum
rebate amount cannot exceed purchase price.
Where can I find a contractor to install the equipment?: Refer to the
ENERGY STAR® website at energystar.gov for tips on how to find the right
contractor, and check the local Yellow Pages for a complete list of licensed
plumbers or heating contractors that specialize in gas heating and water
heating systems.
Payments Assignable to a Third Party: (a) The customer may request that
the incentive be paid directly to a third party by so indicating in the program
application. Notification of third party payment will be sent to the customer
(“Account Holder”) upon submission of the program application for the
purpose of customer confirmation. (b) If no payment choice is made, the
program will send the incentive payment directly to the customer (“Account
Holder”) at the address indicated in the program application. If payee
information is dierent from account holder information and the gas utility
provider is National Grid, additional processing time will be needed for payee
verification.
Incentive Amounts: The program will provide incentives for approved
equipment, equal to the incentive amount indicated in the company’s program
literature and within the program application. Rebates are not available on
refurbished or used equipment. The program reserves the right to change
its incentive amounts in addition to negotiating a lower incentive amount
on a per-unit basis in the case of multiple installations at the same site. The
incentive may not exceed the installed cost of the equipment (excluding
any taxes).
By Your Signature and Acceptance of Energy Efficiency Incentive(s): You
acknowledge that the data collected through the use of the smart thermostat
may be shared with your electric and/or gas distribution company.
Electric Benefits: Other than the energy savings realized by customer,
customer agrees that program administrator has the unilateral right to
apply for any credits or payments resulting from the program or equipment.
Such credits and payments include but are not limited: (a) ISO-NE capacity
payments, (b) other electric or natural gas capacity and avoided cost payments
or credits, (c) environmental credits, and (d) payments from demand response
programs. Customer further agrees customer will not file for such payments
or credits either directly or indirectly, and will not consent to any other third
party’s right to such payments or credits. This right is irrevocable for the life of
the equipment unless the program administrator provides written consent.
Rebate Limitations: Participants who receive equipment incentives through
another energy eciency program oered by the participating utilities are
not eligible to receive incentives directly through this program for the same
equipment. This does not apply to the HEAT Loan financing program.
WE ARE MASS SAVE
®
:
FOR ADDITIONAL INFORMATION, VISIT MASSSAVE.COM/REBATES OR CALL 800-232-0672.