Fillable Heat Pump Training Equipment Reimbursement Application (Efficiency Maine)

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Heat Pump Training Equipment Reimbursement Application (Efficiency Maine)

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The Heat Pump Training Equipment Reimbursement Application (Efficiency Maine) form is 1 page long and contains:

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Send this form to:
Efficiency Maine, PO Box 219, Brunswick, ME 04011–0219 or email it to hesp@efficiencymaine.com
For more information please visit efficiencymaine.com or call (866) 376-2463
6/1/2021
Heat Pump Training Equipment
Reimbursement Application
Use this form to request a reimbursement for the cost of heat pump training equipment. Efficiency
Maine will reimburse 100% of eligible costs up to a maximum of $5,000 per calendar year.
REQUIREMENTS:
☐ 1. Reimbursement request limited to cost(s) of one or more of the following:
a. Heat pump(s)
b. Heat pump component(s)
c. Materials required to install heat pumps
d. Equipment required to install heat pumps
☐ 2. Heat pump products will be used only for training
☐ 3. Costs incurred by an Efficiency Maine Registered Trainer
☐ 4. Cost(s) incurred within the last 90 days
☐ 5. Receipt(s) attached
☐ 6. IRS form W-9 attached
Applicant Information
Efficiency Maine Registered Trainer:
Contact Name:
Email Address:
Phone Number:
Equipment Reimbursement Amount:
(100% of cost up to $5,000)
Signatures. Please certify that all information on this application is correct by signing below.
Signature:
Date:
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Heat Pump Training Equipment Reimbursement Application (Efficiency Maine)

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Completed 23 July 2021

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