Name(Required) First Last Account #(Required)Phone(Required)Type of Phone(Required) Cellphone Home Email(Required) Mailing Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Home Type(Required) Stick-built/Modular Mobile/Manufactured Occupancy Status(Required) Owner Renter/Tenant Landlord Vacation rental Tune-Up Service Cost(Required)Equipment InformationCooling Type(Required) Air conditioner Air source heat pump Mini-split heat pump Geothermal heat pump Outdoor Unit Brand(Required)Outdoor Unit Model #(Required)AHRI Reference #Do you have a maintenance contract?(Required) No 1-Year contract Multi-year contract Upload a copy of your invoice or receipt(Required)Max. file size: 500 MB. Contractor InformationContractor Name(Required)Company(Required)Company Phone #(Required)Contractor Email(Required) I certify that my contractor has completed the following:(Required) Cleansed condenser coil Inspected fins Checked refrigerant charger Lubricated fan motors, if OEM recommended Checked belts, if applicable Cleaned drains Visually inspected entire system Tested all controls Discussed proper system operation with customer Select AllHow did you hear about the incentive?(Required) Newsletter Social media Bartholomew County REMC website WhyElectrify website Word of mouth Other Contractor Confirmation(Required) I certify that a tune-up service was performed by the heating and cooling professional listed in this form.Terms and Conditions Confirmation(Required) I understand and agree to the programs rules and conditions.Eligibility Requirement: • Must be a current Bartholomew County REMC residential member-consumer. • Tune-up service must be in a home served by Bartholomew County REMC. • Applicant must occupy the home where the tune-up was serviced year-round (12 months). • Program eligibility includes prior participation in rebate programs, with incentive and measure caps specific for each program. Applications in excess of program caps will not be processed. HVAC Tune-Up Rebate Program Requirements: • The HVAC Tune-up rebate is designed for tune-up services only on air source heat pumps, geothermal heat pumps and air conditioners. • All applicants must provide a receipt/invoice showing a description of services completed and cost. • Submission for HVAC Tune-up rebate must include application and receipt or invoice showing a description of services completed and cost. Applicant understands no rebate will be given if applicant fails to provide required documentation. • Limit of two rebates per member account per year. Program Parameters: • Applicant agrees to purchase power from Bartholomew County REMC for a period of one year. Should the applicant receive 100% of their power from any source other than Bartholomew County REMC, including generation owned by the customer before the end of one year, the applicant agrees to refund the full amount of the rebate to Bartholomew County REMC. • Hoosier Energy maintains full discretion over the rebate and reserves the right to modify the program at any time. Application Procedures and Deadlines: • Applications are processed on a first-come, first-served basis while funds are available. • Submission for rebates must be within 90 days of service in the same calendar year. • Applications become the property of Bartholomew County REMC and will not be returned. Please keep a copy for your records. Incentive Payments: • Bartholomew County REMC reserves the right to approve or deny incentive. • The incentive payment cannot exceed 50% of the total service cost up to $50 as noted on application. Taxes, fees, and labor cannot be included in the equipment cost. • Rebates may take up to six weeks from receipt of the application by Bartholomew County REMC to process. • Approved rebates will be returned to the applicant in the form of a bill credit or check by mail, via the U.S. Postal Service. • Application approval is not a guarantee of incentive payment. • Bartholomew County REMC reserves the right to withhold payment for services that do not meet the program requirements as determined within its sole discretion. • Incentives are paid as a one-time, one-program offer and cannot be combined with incentive payments, rebates or discount programs from other utility providers. Logo Usage: • Program applicants and program participants may not use any member cooperative or Hoosier Energy logo or name without prior express written permission. Program Disclaimers: • Your electric cooperative and Hoosier Energy REC, Inc. • Does not endorse any particular contractor, manufacturer, product or system design by offering these incentives; • Will not be responsible for any tax liability imposed on any program participant as a result of the payment of incentives; • Does not expressly or impliedly warrant the performance of any purchased equipment or service and hereby disclaim any and all warranties, express or implied, including the warranties of merchantability or fitness for a particular purpose. • Is not responsible for the handling, storage, treatment, transportation or disposal of any waste generated as a result of any measures for which incentives have been applied for and/or received under this program nor any resultant environmental contamination related to the same; • Is not liable for any damage caused by the operation or malfunction of the installed equipment or service by contractor; and • Does not guarantee that a specific level of energy or cost savings will result from the implementation of energy conservation measures or the use of products funded under this program.Electronic Signature Consent(Required) I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today’s date and authorized by me as if I had signed my signature.Applicant Electronic Signature (Full Name)(Required)
