Download the 2023 HVAC Tune-Up Rebate Application (Fillable PDF) Member Name(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Phone(Required)Email(Required) Account Number(Required) Contractor ChecklistOutdoor Inspect safety disconnect Check refrigerant lines Check refrigerant caps Check refrigerant levels Inspect reversing valve (if applicable) Inspect and/or clean outdoor unit coil and wiring Inspect unit is level and draining properly Inspect fan blade balance Inspect capacitor Select AllIndoor Inspect indoor unit coil Inspect filter Examine blower Inspect insulation on refrigerant lines Test indoor capacitor Inspect condensation drain Check static air pressure Inspect thermostat Lubricate system Select AllEquipment InformationAHRI Reference Number Please provide the AHRI Reference number in the field above or complete the following information:Cooling type: Air conditioner Air source heat pump Mini-split heat pump Geothermal heat pump Outdoor Unit Brand Outdoor Model # Indoor Coil Model # Furnace/AH Model # SEER/EER Rating Capacity (BTU Per Hour) How did you hear about the incentive?(Required) Newsletter Social Media Website Word of Mouth Other Please read and sign below to indicate you understand and agree to the following conditions:(Required)All rules and requirements of this program have been followed. Applicant has read and agrees to the Residential Rebate Program Terms and Conditions at sciremc.com/rebates-credits and understands that they are subject to change. Applicant is a residential member of South Central Indiana REMC, an electric cooperative member of Hoosier Energy. The rebated equipment was installed and operational prior to submission of this application. South Central Indiana 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. Applicant understands and agrees that neither Hoosier Energy nor South Central Indiana REMC assumes any responsibility or liability arising out of or related to applicant’s participation in Team Up programs. Applicant will allow inspection of the rebated equipment (if requested). Applicant understands applicant will not receive a rebate if applicant and/or applicant’s contractor fails to provide required program documentation. Applicant agrees to purchase power from South Central Indiana 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. 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. South Central Indiana REMC reserves the right to approve, deny or select the appropriate rebate amount. A copy of the sales invoice must be included with the rebate application. I hereby verify the information to be true and complete and agree to the terms and conditions. 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) NameThis field is for validation purposes and should be left unchanged.
