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Water Heater Rebate Form

Water Heater Rebate

THIS RESIDENTIAL REBATE FOR HEAT PUMP / HYBRID WATER HEATERS ONLY.
To qualify, you must occupy the home where equipment is installed year-round.

Please provide the following documents to your electric cooperative to apply for possible rebates:
– 2023 HPWH Residential Rebate Application
– Proof of purchase (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.