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E1kRiver .� M HVAC EQUIPMENT Municipal Utilities PURIM MI, RESIDENTIAL REBATE APPLICATION EQUIPMENTHVAC QUALIFY .. one date of installation) CENTRAL AC (Units 15.2 SEER2 or higher will qualify. Must be ENERGY STAR" certified) REBATE: $125 / UNIT Quantity NEW UNIT EFFICIENCY I SEER2 Manufacturer Name Cooling Capacity (BTU/hour) EER2 Model Number Date of Install CENTRAL AC TUNE UP REBATE: Up to $75 / UNIT (Must provide professional contractor invoice showing tune up activity performed) Quantity Cooling Capacity (Tons) Unit Efficiency: SEER EER Completed (check all that apply) ❑ Condenser Coil Cleaning & Filter Change ❑ Refrigerant Charge Correction & Air Flow Correction Contractor Name Date of Service MINI SPLIT DUCTLESS AIR CONDITIONER REBATE: $150 / UNIT (Units 15.2 SEER2 or higher will qualify. Must be ENERGY STAR" certified) Quantity Manufacturer Name Cooling Capacity (BTU/hour) Model Number — SEER2 Date of Install AIR CONDITIONER ROOM UNIT/WINDOWAC (MustbeENERGY STAR®certified) REBATE: $10/UNIT Quantity Cooling Capacity (BTU/hour) CEER Rating Features (select one) ❑ Reverse Cycle ❑ Louvered Style (select one) ❑ Sleeve ❑ Window Manufacturer Name Model Number Date of Install REPLACEMENT FURNACE WITH ECM BLOWER MOTOR (Must be ENERGY STARR certified) REBATE: $150 / UNIT Quantity Central AC in Building (select one) ❑ Yes ❑ No Manufacturer Name Model Number Date of Install ECM CIRCULATOR (Must be ENERGY STAR®certified) REBATE: $100 / UNIT (Not to exceed 50% of pump cost) Quantity Pump Wattage Function of Pump (select one) ❑ Domestic Hot Water ❑ Space Heating Hot Water Date of Install THERMOSTAT (Must be ENERGY STAR®certified) REBATE: $20 / UNIT (Programmable) or $40 / UNIT (WiFi compatible) Quantity Heating Type (select one) ❑ Electric ❑ ASHP ❑ GSHP ❑ Gas New Thermostat Type (select one) ❑ Tier 1 (Programmable) ❑ Tier 2 (Communicating - WiFi) ❑ Tier 3 (Analytics Capable - WiFi) Manufacturer Name Model Number Date of Install a