Download the 2023 Water Heater Rebate Application (Fillable PDF) Name(Required) First Last Member Account Number(Required) Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code 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 Country Phone(Required)Email(Required) Home InformationBuilding Type(Required) Mobile/Manufactured Single Family Construction Type(Required) New Construction Existing Home Occupancy Status(Required) Owner Renter Vacant Tenant Landlord Housing Type(Required) Stick-build or Modular Mobile or Manufactured Year Home was Built(Required) Contractor InformationContractor Name(Required) Phone(Required)Email Installation InformationInstallation Date(Required) MM slash DD slash YYYY Who installed the equipment?(Required) Total Project Invoice(Required)Heat Pump Equipment Cost (Excluding Labor)(Required)# of Units Installed(Required)Manufacturer(Required) Efficiency Rating(Required)Size (Gallons)(Required)Where was the equipment purchased from?(Required) Type of Home HVAC(Required) Unit Model #(Required) Unit Serial #(Required) Building Contractor(Required) Please upload a copy of the sales invoice, and before and after pictures of the equipment.(Required) Drop files here or Select files Max. file size: 170 MB. 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, before and after pictures of the equipment and an AHRI certificate 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)
