Fillable Form 2021: Residential mini-split heat pump rebate form (Mass Save)

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Form 2021: Residential mini-split heat pump rebate form (Mass Save)

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2021
Residential mini-split
heat pump rebate form
WE ARE MASS SAVE®:
2021 residential mini-split heat pump rebate
Save with rebates on mini-split heat pump equipment installed between January 1, 2021 and December 31, 2021.
Rebate not to exceed purchase price. Limit five (5) rebates per electric meter.
STANDARD MINI-SPLIT HEAT PUMP REBATES
Equipment Type Efficiency Requirements Rebate Amount
1
Mini-Split Heat Pump Refer to Heat Pump Qualified Products List at MassSave.com/HPQPL $250 per ton
FUEL OPTIMIZATION MINI-SPLIT HEAT PUMP REBATES
Equipment Type
Efficiency
Requirements
Primary Fuel Type
Additional
Requirements
R
ebate Amount
1
Mini-Split Heat Pump
Refer to Heat Pump
Qualified Products
List at
MassSave.com/HPQPL
Oil or Propane
Integra
ted Controls
2
required unless
central heating system is removed.
3
Refer to Integrated Controls Qualified
Products List at MassSave.com/ICQPL
$1,250 per ton
Electric Resistance
Heat
900 kWh dierence between sum of 3
winter-usage and 3 lowest-usage months
Integrated Controls
2
Add-on to existing
mini-split heat pump
Oil or Propane
Refer to Integrated Controls Qualified
Products List at MassSave.com/ICQPL
Up to $500 per indoor unit,
max of $1,500
1
Actual tons are calculated based on AHRI cooling capacity divided by 12,000 BTUs. Rebate amount based on actual tons.
2
Integrated controls are either approved control packages or dual fuel thermostats that switch between a heat pump and a central heating system.
3
The Sponsors of Mass Save® do not recommend fully replacing existing central heating systems with heat pump equipment. Customers that choose to do so may access the Fuel Optimization
incentive levels without the installation of an integrated control.
Please see Terms & Conditions for full requirements. Cannot be combined with other rebate for same equipment.
INTEGRATED CONTROLS
Integrated Controls are designed to automatically switch between a heat pump and a conventional heating system at a
pre-set temperature, creating a more ecient way to heat a home. As each home’s heating need is unique, work closely with
your contractor to determine whether integrated controls are a good fit.
NEXT STEPS
1. Work with a licensed HVAC contractor to determine if mini-split heat pumps are right for your home.
Before installation, consider the following:
Use with your existing heating system
Using mini-split heat pumps in the winter to complement your existing heating system can reduce your overall heating
costs without sacrificing comfort. The highest cost savings occur when mini-splits serve as the primary source of heat for
an entire zone currently heated by a baseboard electric, oil or propane heating system.
For more information, visit MassSave.com/MSHP
2. Interested in 0% financing?
Apply for a Mass Save HEAT Loan prior to installing your equipment. Learn more at MassSave.com/HEATLoan
3. Oers valid only for residential electric customers in MA where the Mass Save Electric Heating and Cooling
Program is oered by Cape Light Compact, Eversource, National Grid and Unitil.
4. Upon completion of installation, apply for a rebate by submitting all required documentation online at
MassSave.com/Rebates or by mail to Mass Save Residential Heating & Cooling Program, P.O. Box 2528,
Manchester, CT 06045
FOR ADDITIONAL INFORMATION, VISIT MASSSAVE.COM/REBATES OR CALL 800-232-0672.
WE ARE MASS SAVE®:
❍ ❍ ❍ ❍ ❍
❍ ❍
2021 residential mini-split heat pump rebate form
1. To receive your rebate faster, submit online at MassSave.com/Rebates
2. By mail, send all required documentation to Mass Save Residential Heating & Cooling Program, P.O. Box 2528, Manchester, CT 06045
REQUIRED DOCUMENTS*
1. *Completed and signed application. 2. *Copy of your most recent electric utility bill. 3. *Contractor’s invoice including:
*Equipment Make *Coil and Condenser Model Numbers *Size in Tons *Installation Date and Address *Total Install Cost and Proof of Payment
*Contractor Information Fuel Optimization rebates only: *A copy of your most recent oil or propane bill and Manual J or additional electric
bills for electric resistance.
*Required Fields/Documents
Note: Completed rebate application and required documentation must be submitted by January 31, 2022. Rebate processing time is typically less when submitting online.
*Required Fields/Documents
CUSTOMER INFORMATION (FILL CIRCLES COMPLETELY)
Residential Electric Utility or Energy Eciency Provider:* Cape Light Compact Eversource National Grid Unitil
Account Holder Name:*
Electric Account Number:* Is this property primarily occupied by the owner or a renter? Owner Renter
Installation Address:
(must match the residential electric account address)
* City:* State:*
MA
ZIP Code:*
Phone Number: Email:
Customer Signature: Date:
I certify that all information is correct to the best of my knowledge and that I adhere to all terms and conditions of this rebate.
MAILING ADDRESS FOR REBATE (IF DIFFERENT FROM ABOVE)
Payee Name: Phone Number: Email:
Address: City: State: ZIP Code:
AHSP TABLE
Pre-Existing Fuel Type: Electric Resistance Heat Oil Propane Gas None
New Mini-Split Heat Pump Equipment Installed (CANNOT APPLY FOR MULTIPLE REBATE OFFERS FOR SAME EQUIPMENT INSTALLATION)
Rebate Type Rebate Amt.
Install
Date
AHRI
Reference #
Integrated Control Model Number(s)
(not applicable for standard rebates, electric heat or
full oil/propane displacement)
# of Tons
(1 Ton =
12,000 BTUs)
Customer
Rebate
(Rebate Amt. x
# of Tons)
Standard Mini-Split Heat Pump
$250 per ton
n/a
Standard Mini-Split Heat Pump
$250 per ton
n/a
Fuel Optimization Mini-Split
Heat Pump
$1250 per ton
Fuel Optimization Mini-Split
Heat Pump
$1250 per ton
In the past year, electric resistance has been used to heat my home all winter. Yes No
See Terms and Conditions on back for further information
I have elected to remove my oil or propane
central heating system. Yes No
Type of equipment removed: Forced hot water or steam sys
tem Forced hot air system
Note: The Sponsors of Mass Save do not recommend fully displacing existing central heating system with heat pump equipment.
Integrated Controls
(ADD-ON TO EXISTING HEAT PUMP INSTALLATION)
Install Date
Integrated Control Model Number(s)
(Not applicable for electric heat or full displacement)
# of Indoor Units
(3 unit max)
Customer Rebate
$
$
CONTRACTOR INFORMATION
Note: All contractor information contained in this section is required on the c
ontractor’s invoice.
Company Name:* Contact Person:*
City:* State:
* ZIP Code:*
Phone Number:* Email:*
Please allow 6–8 weeks for processing. For more information, to confirm eligibility or to check the status of your rebate,
call 800-232-0672 or email ask@efi.org
FOR ADDITIONAL INFORMATION, VISIT MASSSAVE.COM/REBATES OR CALL 800-232-0672.
$ 0.00
$ 0.00
$ 0.00
$ 0.00
click to sign
signature
click to edit
TERMS AND CONDITIONS
Equipment Requirements
Mini-split units must be qualified, listed with and certified by the Air
Conditioning, Heating, and Refrigeration Institute (AHRI), and meet the
program SEER and HSPF requirements.
SEER and HSPF ratings for condenser, and coil (if applicable) must be
provided. Both the Consortium for Energy Eciency (ceehvacdirectory.org)
and the AHRI directory (ahridirectory.org or call 703-600-0384) websites
list SEER and HSPF values. AHRI also provides AHRI numbers. For a qualified
products list for integrated controls, refer to MassSave.com/ICQPL. AHRI SEER
and HSPF rating of outdoor condenser and indoor coil working together. One
ton is 12,000 BTU/h. Rounding up of SEER or HSPF ratings is not acceptable.
General Requirements
Application Form: This application must be filled out completely, truthfully,
and accurately. The customer must date and submit the completed application
along with all required documentation for specific rebates and/or incentives.
By submitting the rebate application, the customer agrees to abide by these
Terms and Conditions.
Time Limit: Qualifying units for equipment rebate must be purchased and
installed between January 1, 2021 and December 31, 2021. Applications must be
postmarked by January 31, 2022. Program is subject to change without prior
notice, including rebates and incentive levels.
Payments: From the time the application is processed and approved,
please allow 6–8 weeks for payment. Payment processing will take longer
if information or documentation is missing from the application. If payee
information is dierent from account holder information and the electric utility
provider is National Grid, additional processing time will be needed for payee
verification.
Geographic Requirements:
Oers valid only for residential electric
customers in MA where the Mass Save Electric Heating and Cooling
Program is oered by Cape Light Compact, Eversource, National Grid
and Unitil.
Rebate Limitations: This rebate may not be combined with any other utility
or energy eciency service provider oer for the same equipment. This does
not apply to the HEAT Loan financing program. Other, non-Mass Save rebates
or incentives may also be used. Rebate amount not to exceed the cost of
equipment (excluding sales tax and all installation costs) and may be subject to
change without notice. Equipment installed in new construction is not eligible
if incentives have already been received through Renovations & Additions or
Residential New Construction.
Proof of Purchase: A copy of the customer’s invoice itemizing the purchased
equipment must accompany each rebate application form. The invoice must
indicate the equipment make, coil and condenser model numbers, size in tons,
installation date and address, total install cost and proof of payment.
Contractor Certification: Contractor certifies that installation and services
performed have been in accordance with all applicable municipal, state and
federal codes, standards and regulations, as well as program requirements
pertaining to the installed system.
Approval and Verification: The participating utility or energy eciency service
provider reserves the right to conduct field inspections to verify installations.
Tax Liability: Sponsors will not be responsible for any tax liability that may be
imposed on the customer or contractor as a result of the payment of rebates.
Endorsement: Sponsors do not endorse any particular manufacturer, product,
system design, or technology in promoting these oers.
Limitation of Liability: Sponsors and their rebate administrator’s liability is
limited to paying the rebate and incentive specified. Sponsors and their rebate
administrator are not liable for any consequential or incidental damages or for
any damages in tort connected with or resulting from participation in these
oers.
Warranties: SPONSORS DO NOT WARRANT THE PERFORMANCE OF
INSTALLED OR SERVICED EQUIPMENT, EXPRESSLY OR IMPLICITLY. Program
sponsors make no warranties or representations of any kind, whether
statutory, expressed, or implied, including, without limitations, warranties or
merchantability or fitness for a particular purpose regarding the equipment or
services provided by a manufacturer or vendor. Contact your contractor for
details regarding equipment performance and warranties.
Electric Benefits: Other than the energy cost savings realized by customer, the
program administrator is entitled to 100% of the benefits and rights associated
with the energy-ecient measures, including without limitation ISO-NE
products and all other attributes, credits or products associated therewith
under any regional initiative or federal, state or local law, program or regulation
or program, and customer waives, and agrees not to seek, any right to the
same.
Electric Resistance Heat Replacement Adder: To be eligible, customer
must show that electric resistance was used to heat their home all winter by
submitting an electric bill that shows a 900 kWh dierence between the sum
of the three winter-usage and three lowest-usage months.
WE ARE MASS SAVE®:
FOR ADDITIONAL INFORMATION, VISIT MASSSAVE.COM/REBATES OR CALL 800-232-0672.
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Completed 22 July 2021

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