Fillable BIOMASS BOILER/FURNACE Rebate Claim Form (Efficiency Maine)

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BIOMASS BOILER/FURNACE Rebate Claim Form (Efficiency Maine)

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The BIOMASS BOILER/FURNACE Rebate Claim Form (Efficiency Maine) form is 1 page long and contains:

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  • 17 check-boxes
  • 12 other fields

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File type: PDF

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BIOMASS BOILER/FURNACE
Rebate Claim Form
Please submit by email: hesp@efficiencymaine.com OR Fax: 207-622-9933 OR Mail: PO Box 219, Brunswick, ME 04011–0219
Please allow 6 weeks for rebate processing.
Rev. 6.1.2021
REQUIREMENTS CHECKLIST all boxes must be checked
☐ 1. On Efficiency Maine’s list of rebate-eligible biomass boilers and furnaces
☐ 2. Invoice(s) attached, showing:
a. Full model number and manufacturer
b. Installation cost before rebate
c. Completion date
d. Installation address
☐ 3. Installed in a home or business located in Maine
☐ 4. Installed by a pellet boiler Efficiency Maine Residential Registered Vendor
☐ 5. Rebate claim submitted:
a. within 12 months of installation for upgrades completed on or before 4/30/2021
b. within 90 days of installation for upgrades completed on or after 5/1/2021
NOTE: Lifetime limit is one rebate per dwelling. Program subject to change without notice.
Building Owner Name:
Installation Address, Town, State, ZIP:
Mailing Address, Town, State, ZIP:
Email Address:
Phone Number:
Replaced Heating Fuel (if any):
☐ Oil ☐ Kerosene ☐ Propane ☐ Natural Gas ☐ Wood ☐ Electricity ☐ Other
Biomass Boiler/Furnace Manufacturer
Model Number
Installation cost before rebate
$
Rebate (1/3 total project cost up to $6,000)
$
Rebated unit installed in:
☐ Home ☐ Business
Rebate Recipient:
☐ Building Owner ☐ Registered Vendor
Residential Registered Vendor Company Name
SIGNATURES. Please certify that all information on this Claim Form is correct by signing below. By submitting this claim, I agree
to allow Efficiency Maine to verify installation and perform an inspection. If building access is required for an inspection, I agree
to work with Efficiency Maine to schedule a mutually convenient time. I understand that Efficiency Maine may contact me about
my experience on this project and I consent to receive program-related email and/or phone communications from Efficiency
Maine and its service providers.
☐ Yes, I'm interested in a free, independent inspection by Efficiency Maine
Registered Vendor Signature:
Date:
Building Owner Signature:
Date:
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BIOMASS BOILERFURNACE Rebate Claim Form (Efficiency Maine)

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Completed 23 July 2021

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