I need to submit a rebate application for:

Please read and check below to indicate you understand and agree to the following conditions: 1. All rules and requirements of this program have been followed. 2. Applicant has read and agrees to the Residential Rebate Program Terms and Conditions at dmremc.com. 3. Applicant is a residential member of Daviess-Martin REMC, an electric cooperative member of Hoosier Energy. 4. The rebated equipment was installed and operational prior to submission of this application. 5. Daviess-Martin REMC is providing the electric service to the installation site address listed on this application. Rebated equipment is installed in the primary residence of the applicant. 6. Applicant understands and agrees that neither Hoosier Energy nor Daviess-Martin REMC assumes any responsibility or liability arising out of or related to applicant’s participation in Team Up programs. 7. Applicant will allow inspection of the rebated equipment (if requested). 8. Applicant understands applicant will not receive a rebate if applicant and/or applicant’s contractor fails to provide required program documentation. 9. Applicant agrees to purchase power from Daviess-Martin REMC for a period not less than the deemed measured useful life of rebated equipment. Should the applicant receive power from any source other than the electric cooperative, including generation owned by the customer, before the end of the equipment’s deemed useful life, the applicant agrees to refund the full amount of the rebate to the distribution cooperative. 10. Applicant gives permission to Hoosier Energy to obtain usage information from their electric cooperative. Applicant understands that Hoosier Energy may use the usage information provided for program evaluation and analysis. If signing in a capacity other than an individual capacity, the individual signing below hereby represents and warrants that s/he is duly authorized to execute and deliver this application on behalf of the applicant. 11. Daviess-Martin REMC reserves the right to approve, deny or select the appropriate rebate amount.

Will this rebate be mailed to the contractor instead of being claimed by the member?

By checking below, I assign the full Team Up incentive amount pursuant to this application to the individual or entity designated as “Contractor” listed above and agree that such assignment can only be amended or modified in writing acknowledged by member cooperatives and Hoosier Energy, and further agree to hold harmless and indemnify member cooperatives and Hoosier Energy from any claim made for such incentive amount or from any loss resulting from the payment of the incentive amount to the assignee.

Heat Pump Type

Geothermal Heat Pump (GHP) Type

(GHP) Desuperheater installed?

(GHP) Propane/gas back-up?

Electric Resistance Replacement Air Source/Dual Fuel (HPRER)

Ductless Mini-Split Heat Pump (DMSHP)

Submission of application expressly indicates member understanding and agreement to the following conditions: Limit of two rebates per household. Rebates for HVAC equipment are available for whole home installations only unless otherwise stated. To receive a rebate, all homeowners must provide AHRI (Air conditioning, Heating and Refrigeration Institute) validation for all SEER and EER ratings that can be obtained from the installing heating and cooling dealer. No rebate will be awarded based on HVAC dealer bid specifications, promotional material of dealer, manufacturer or any other source than AHRI. A certificate of AHRI-certified performance must be submitted. All homeowners must complete a rebate application form and provide proof of purchase to receive any 2021 rebate. Deadline to apply for 2021 Rebate Program is Dec. 15, 2021. The cooperative reserves the right to approve, deny or select the appropriate rebate. The co-op also reserves the right to inspect and verify installation of equipment receiving a rebate.

Does the heat pump have a gas furnace (Dual Fuel)?