Ductless Heat Pump Rebate Agreement

Site Address(Required)
If unknown, please estimate
Type of primary electric resistance heat in the home?(Required)
Which of the following describes the home?(Required)

Zonal heating includes electric, non-ducted: ceiling cable, wall, baseboard, and an electric boiler/water heater attached to a zoned hydronic floor heating system.

Homes with an electric forced air furnace, multifamily residences or manufactured homes may qualify for a utility incentive, but currently do not qualify for the Bonneville Power Administration (BPA) program. Please check with your electric utility for eligibility. To be eligible for incentive payment under the BPA program the home must have permanently installed zonal electric resistance heat as the primary heating system. A qualifying home cannot: (i) be new construction, (ii) have a fossil fuel central forced air or fossil fuel hydronic heating system, nor (iii) have a ducted heat pump system.

The undersigned utility customer requests and authorizes the specified utility to release billing and usage information for the account listed below to the BPA or its agent. With this authorization, the BPA can request billing information for up to two years pre -installation and two years post-installation. The utility customer also hereby releases the utility company from any and all liability arising from or connected with providing this information. The homeowner also agrees to the terms and conditions listed on the back of this form.

Installation Information

MM slash DD slash YYYY
Including: equipment, labor, electrical, tax, permit and other (prior to rebate)
Drop files here or
Max. file size: 499 MB.
    This form, approved for use by BPA, April 1, 2012.

    Contractor Signature Release

    By signing below, the contractor certifies that this invoice form and all accompanying documents are complete and accurate. The signature certifies that the contractor is licensed, bonded, insured, has been trained by the manufacturer of the installed product and has received project contractor orientation. By signing this, the contractor has read and understood the terms and conditions listed on this form and/or project information on the NW Ductless Heat Pump Project website (https://www.GoingDuctless.com).
    MM slash DD slash YYYY
    Work or Cell?(Required)
    This form, approved for use by BPA, April 1, 2012.