Fillable RESIDENTIAL WEATHERIZATION Rebate Claim Form (Efficiency Maine)

Fill Online, Printable, Fillable, Blank RESIDENTIAL WEATHERIZATION Rebate Claim Form (Efficiency Maine) Form

Use Fill to complete blank online EFFICIENCY MAINE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

RESIDENTIAL WEATHERIZATION Rebate Claim Form (Efficiency Maine)

On average this form takes 13 minutes to complete

The RESIDENTIAL WEATHERIZATION Rebate Claim Form (Efficiency Maine) form is 4 pages long and contains:

  • 0 signatures
  • 44 check-boxes
  • 32 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your Efficiency Maine forms online.

BROWSE EFFICIENCY MAINE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
RESIDENTIAL WEATHERIZATION
Rebate Claim Form
Please submit by email: hesp@efficiencymaine.com OR Fax: 207-622-9933 OR Mail: PO Box 219, Brunswick, ME 04011–0219
Please allow 6 weeks for rebate processing.
Page 1 of 4
Rev. 6.1.2021
REQUIREMENTS CHECKLIST all boxes must be checked
☐ 1. Installed in a 1- to 4-unit residential building located in Maine. Larger buildings, including 5 or more attached
condominiums, are not eligible.
☐ 2. Installed in primary living area, not a garage or outbuilding
☐ 3. Rebate claim submitted within:
a. 12 months of installation for upgrades completed on or before 4/30/2021
b. 90 days of installation for upgrades completed on or after 5/1/2021
☐ 4. Installed by an Efficiency Maine Residential Registered Vendor who is qualified in all applicable service categories
☐ 5. Building is principal, year-round residence for occupants, not a seasonal, second, or vacation home
NOTE: Lifetime limit of one wall insulation, one attic insulation, one basement insulation, and one air sealing rebate per
building. Program subject to change without notice.
Homeowner Name:
Installation Address, Town, State, Zip:
Mailing Address, Town, State, Zip:
Email Address:
Phone Number:
Number of dwellings in building:
(A dwelling is a residential unit with a dedicated
kitchen, sleeping area, and bathroom.)
☐ ☐ 1
☐ ☐ 2
☐ ☐ 3
☐ ☐ 4
Primary Heating Fuel:
☐ Oil ☐ Kerosene ☐ Propane ☐ Natural Gas ☐ Wood ☐ Electricity ☐ Other
Energy Assessment and Air Sealing Rebate (from page 2)
$
Attic Insulation Rebate (from page 2)
$
Wall Insulation Rebate (from page 3)
$
Basement Insulation Rebate (from page 3)
$
Next-Step Bonus – $100 for the first rebate-eligible insulation upgrade following an
Energy Assessment and Air Sealing rebate
$
TOTAL REBATE AMOUNT:
$
Rebate Recipient:
☐ Homeowner ☐ Registered Vendor
Residential Registered Vendor Company Name:
☐ Yes, I'm interested in a free, independent inspection by Efficiency Maine.
Registered Vendor Signature:
Date:
Homeowner Signature:
Date:
RESIDENTIAL WEATHERIZATION
Rebate Claim Form
Page 2 of 4
Rev. 6.1.2021
ENERGY ASSESSMENT AND AIR SEALING
Total installation cost (at least $600 before rebate)
$
Rebate
$ 400
ATTIC INSULATION
Pre-Upgrade R-Value
Post-Upgrade R-Value
Square Feet Insulated
Installation cost before rebate
$
Rebate (30% insulation cost up to $1,000)
$
Please submit by email: hesp@efficiencymaine.com OR Fax: 207-622-9933 OR Mail: PO Box 219, Brunswick, ME 04011–0219
Please allow 6 weeks for rebate processing.
RESIDENTIAL WEATHERIZATION
Rebate Claim Form
Page 3 of 4
Rev. 6.1.2021
WALL INSULATION
Pre-Upgrade R-Value
Post-Upgrade R-Value
Square Feet Insulated
Installation cost before rebate
$
Rebate (30% insulation cost up to $1,000)
$
BASEMENT INSULATION
Pre-Upgrade R-Value
Post-Upgrade R-Value
Square Feet Insulated
Installation cost before rebate
$
Rebate (30% insulation cost up to $1,000)
$
Please submit by email: hesp@efficiencymaine.com OR Fax: 207-622-9933 OR Mail: PO Box 219, Brunswick, ME 04011–0219
Please allow 6 weeks for rebate processing.
RESIDENTIAL WEATHERIZATION
Rebate Claim Form
Page 4 of 4
Rev. 6.1.2021
BPI SAFETY TEST
Required for all insulation rebates
Post Upgrade
Blower Door (CFM50)*
BPI combustion safety test
☐ ☐ Pass
☐ ☐ Fail
☐
Carbon monoxide detector present
☐ ☐ Yes
☐ ☐ No
☐
Please submit by email: hesp@efficiencymaine.com OR Fax: 207-622-9933 OR Mail: PO Box 219, Brunswick, ME 04011–0219
Please allow 6 weeks for rebate processing.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

RESIDENTIAL WEATHERIZATION Rebate Claim Form (Efficiency Maine)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 23 July 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document