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• Air Source Heat Pump Tune Up <br />• Central and Ductless Heat Pumps <br />• Cold Climate Heat Pumps�,Q xs <br />• Ground Source Heat Pumps <br />• Heat Pump Water HeaterJ, <br />See back for details regarding specific rebate requirements. <br />Take advantage of ERMU's heat pump rebates for on -the -spot savings and year-round comfort. Consider the sustainability of a heat <br />pump when upgrading your home's heating and cooling system and experience reduced energy usage with increased savings. <br />How to Receive a Rebate <br />(Valid for customers of Elk River Municipal Utilities only. Rebates come in the form of bill credit.) <br />1 Complete the front and back of this rebate form. 4 Mail or bring to <br />2 Include a copy of the original itemized sales receipt Elk River Municipal Utilities <br />and/or invoice for each qualifying product. ATTN Rebate Program <br />3 Include a copy of the AHRI Certificate of Product Ratings. 13069 Orono Pkwy NW, Elk River, MN 55330 <br />This document can be provided by your contractor. OR Email customerserviceC ermumn.com <br />CUSTOMER INFORMATION (please complete all information below) <br />Name Phone County <br />Install Address City State Zip <br />Email Account # <br />Building Type (select one) ❑ Single Family ❑ Multi Family <br />Email Address <br />OR <br />SCAN HERE <br />to submit <br />documents <br />online. <br />RETAILER /CONTRACTOR /INSTALLER INFORMATION <br />Company Name Phone <br />Mailing Address City <br />CERTIFICATIONS AND SIGNATURE <br />I hereby certify that <br />• The information contained in this application is accurate and complete. <br />• All installation is complete, and the unit(s) is operational prior to submitting application. <br />• All rules of this rebate program have been followed. <br />I agree to verification of equipment installation which may include a site inspection by a program or utility representative. I understand that I <br />am not allowed to receive more than one rebate from this program on any piece of equipment. I agree to indemnify, defend, hold harmless <br />and release ERMU from any claims, damages, liabilities, costs and expenses (including reasonable attorney's fees) arising from or relating <br />to the removal, disposal, installation or operation of any equipment or related materials in connection with the programs described in this <br />application, including any incidental, special or consequential damages. <br />ERMU reserves the right to reject any rebate application submitted as a result of work performed by a contractor who has failed to adhere <br />to the terms and conditions established for the rebate program. <br />Homeowner Signature Print Name Date <br />