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HVAC Incentive Program Form

HVAC Incentive Program

UDWI IS OFFERING A 2023 RESIDENTIAL REBATE FOR QUALIFYING EQUIPMENT (GEOTHERMAL HEAT PUMPS AND AIR SOURCE, DUCTLESS MINI-SPLIT OR DUAL-FUEL HEAT PUMPS ONLY).

To qualify, you must occupy the home where equipment is installed year-round (12 months) and the unit must heat and cool the entire home unless otherwise stated.

Please provide the following documents to apply for possible rebates*:
-AHRI (Air conditioning, Heating and Refrigeration Institute) certificate for validation for all SEER and EER ratings. (This can be obtained from the installing heating and cooling dealer.)
-2023 HVAC Residential Rebate Application
– Proof of purchase (paid invoice or receipt)

Your application must be completed and signed, as well as submitted within 30 days of the installation date.

Member Name
Member Name
First
Last
Street Address
Street Address
City
State/Province
Zip/Postal
Contractor’s Name
Contractor's Name
First
Last
Contractor’s Address
Contractor's Address
City
State/Province
Zip/Postal
Building Type
Construction Type
Housing Type
Occupancy Status
If the rebate will be mailed to the contractor instead of being claimed by the member, please complete the following section:

Member Applicant Assignment of Payment to Non-Applicant/Contractor/Vendor: By initialing and checking below, I assign the full 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.

Make rebate payment to Contractor/Vendor
1666 West State Road 54
Bloomfield, Indiana 47424

Hours:  Monday – Friday, 7:30 a.m. to 4:30 p.m.

Office: (812) 384-4446
Toll-Free: (800) 489-7362
©2021 Utilities District of Western Indiana REMC. Member-Owned. Member-Focused.