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Rebate Application Form

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20200601 | Page 1 of 4PPL Electric Utilities
BONUS ($75)
Installed on eligible HVAC system and applied for a PPL rebate in the last 90 days.
Home Information
*Cooling
System Type
Central A/C Geothermal Heat Pump None
Room A/C Air Source Heat Pump
*Cooling System Installation
Date
Before 1/23/06 Between 1/23/06 and 6/1/15
After 6/1/15 N/A
* Primary Heating System
(heating the largest area of
the home)
Electric Resistance (baseboard) Air-Source Heat Pump Propane
Natural Gas Geothermal Heat Pump Other
Customer Information
—
*PPL Electric Utilities 10-Digit Account #
*First Name *Last Name
*Service Address
*City *State *ZIP Code
*Phone Email
Mailing Address (if different from your service address)
City State ZIP Code
*Is natural gas distribution system available to your home or business?
Yes
No
Dollar amount of other (non-PPL) rebates/incentives you may also be receiving
for this purchase (this information does not change the amount of your PPL
rebate)
Business Name (if applicable)
Business Type
Government (federal/state/local)
Non-prot Organization
School
None of the above
Tax Status (if applying on behalf of a business)
Sole Proprietor
Partnership
Government Non-Prot
Corporation
Religious
Tax ID
How did you hear about PPL rebates?
Newspaper
Radio
Television
Word of Mouth
PPL Bill Insert Email
Social Media
Digital Banner
PPL Website
Mail
Internet Search
Other
Contractor/Trade Ally
In-Store/Salesperson
$
*Indicates Required Field
Rebate Application Form
Weatherization
SIGNATURE REQUIRED ON PAGE 4
Weatherization Product Information
Product
Eligibility
Home Heating/Cooling: insulation, duct sealing and air sealing must take place in an existing permanent dwelling with living quarters.
Home must have primary electric heat, or central A/C with non-electric heat.
Contractor
Company Name Installer Name Email Telephone #
Address City State ZIP Code
*Indicates Required Field
20200601 | Page 2 of 4PPL Electric Utilities
Typical Insulation R-Values Reference Chart
Can be used to estimate existing and new R-Values
*Insulation Material - Select installed material R-Value per inch Typical Applications
Cellulose, loose ll
3.7 Attic Floor
Cellulose, high density
3.2 Walls, Enclosed Cavities
Fiberglass, batts
3 Open Stud Walls, Attic Floor
Fiberglass, loose ll
2.8 Attic Floor, Walls
Rockwool
3 Attic Floor, Walls
Vermiculite
2.7 Attic Floor
Poly-isocyanurate, rigid board
7 Walls, Attic Access Doors
Polystyrene, expanded rigid board
4 Walls
Polystyrene, extruded rigid board
5 Walls
Low Density Urethane, sprayed foam
3.7 Attics, Walls
Urethane, sprayed foam
6 Attics, Walls
Urea Formaldehyde Foam
4 Attics, Walls
Other ____________________________
____________________________ ____________________________
Wall Insulation
Measure
*Previous Inches
of Insulation
*New Insulation
Insulation R-values
Reference Chart Selection
*Date
Installed
*Added
R-Value
*Area Insulated
(sq. ft.)
Item Cost On
Invoice
Wall 1
Insulation
_______
Inches
x2.5
Batt Spray-on
Loose Rigid Board
Other ____________________
R-_____
Wall 2
Insulation
_______
Inches
x2.5
Batt Spray-on
Loose Rigid Board
Other ____________________
R-_____
Attic Insulation
Measure
*Previous Inches
of Insulation
*New Insulation
Insulation R-Values
Reference Chart Selection
*Date
Installed
*Added
R-Value
*Area Insulated
(sq. ft.)
Item Cost On
Invoice
Attic
Area 1
Insulation
_______
Inches
x2.5
Batt Spray-on
Loose Rigid Board
Other ____________________
R-_____
Attic
Area 2
Insulation
_______
Inches
x2.5
Batt Spray-on
Loose Rigid Board
Other ____________________
R-_____
Rebate
Measure Rebate Amount
Electric Heat
Rebate Max
Central A/C and Non-Electric Heat
Rebate Max
Wall Insulation 75% of cost
†
$450 $125
Rebate Application Weatherization
SIGNATURE REQUIRED ON PAGE 4
*Indicates Required Field
Insulation Product Information
Product
Eligibility
Wall Insulation: the existing insulation R-value cannot exceed R-11 (uninsulated walls are considered to have a base R-value of 5 ) and
the insulation added must be greater than R-6.
Insulation installed in new home construction, workshops, garages, crawl spaces and outbuildings is not eligible.
Rebate
Measure Rebate Amount
Electric Heat
Rebate Max
Central A/C and Non-Electric Heat
Rebate Max
Attic Area Insulation 75% of cost
†
$450 $125
Product
Eligibility
Attic Insulation: the existing R-Value cannot exceed R-30 (~10 inches of insulation). A minimum of R-11 must be installed to achieve a
nal R-value between R-38 and R-49. Attic is the space directly beneath the roof of a structure.
Insulation installed in new home construction, workshops, garages, crawl spaces and outbuildings is not eligible.
One attic and one wall insulation rebate per home
R-Value equals 2.5 times the number of inches of your previous insulation.
†
A labor invoice must be attached to qualify.
†
A labor invoice must be attached to qualify.R-Value equals 2.5 times the number of inches of your previous insulation.
20200601 | Page 3 of 4PPL Electric Utilities
Duct Sealing
Measure *Date Installed Item Cost on Invoice
*Blower Door Test
In Envelope Only
(Pre CFM50)
*Blower Door Test
Out Envelope Only
(Post CFM50)
Duct Sealing
*Pre-Sealing CFM50 Result Whole House (pre-duct sealing) *Pre-Sealing SCF
*Post-Sealing CFM50 Result Whole House (post-duct sealing) *Post-Sealing SCF
Building Sq. Ft.
______________
Foundation Type:
Unnished
Finished
Crawl Space
Slab
Unknown
Other
HVAC System Manufacturer HVAC System Model
*Rated Cooling Capacity (BTU/hr) *Rated Heating Capacity (BTU/hr)
Air Sealing
Measure *Date Installed Item Cost on Invoice
*Blower Door Test In
(Pre CFM50)
*Blower Door Test Out
(Post CFM50)
Air Sealing
*Did home pass post-air sealing combustion safety zone testing? Yes No No Combustion Appliance
*Inltration Treatments
and Locations of
Air Sealing
Caulk Windows
_________________________________
_________________________________
_________________________________
Caulk Doors
_________________________________
_________________________________
_________________________________
Weather Stripping
_________________________________
_________________________________
_________________________________
Spray Foam
_________________________________
_________________________________
_________________________________
Air Barrier Realignment
_________________________________
_________________________________
_________________________________
Other
_________________________________
_________________________________
_________________________________
Building Sq. Ft.
______________
Foundation Type:
Unnished
Finished
Crawl Space
Slab
Unknown
Other
Building Siding Type:
Brick
Vinyl
Masonry
Wood
Aluminum
Other
Rebate
Measure Rebate Amount
Electric Heat
Rebate Max
Air Sealing $0.25 per cubic feet per minute (CFM) reduction $100
†
Rebate
Measure Rebate Amount
Electric Heat
Rebate Max
Central A/C and Non-Electric Heat
Rebate Max
Duct Sealing $75 $75 $75
SIGNATURE REQUIRED ON PAGE 4
Rebate Application Weatherization
*Indicates Required Field
†
Must show at least 10% improvement and at least a 100 CFM reduction
Duct Sealing Product Information (duct leakage and blower door testing required)
Air Sealing Product Information (duct leakage and blower door testing required)
Product
Eligibility
Must be performed in accordance with BPI standards with pre- and post-blower door testing.
Must show at least 10% improvement and equate to a $25 minimum rebate amount to qualify.
Air sealing performed in new home construction, workshops, garages, crawl spaces and outbuildings is not eligible.
Product
Eligibility
Must include pre-and post-duct leakage to exterior test results.
Must be attached to air source heat pump or electric furnace.
Duct sealing installed in new home construction, workshops, garages, crawl spaces and outbuildings is not eligible.
20200601 | Page 4 of 4PPL Electric Utilities
Terms & Conditions
Checks will be mailed to qualifying customers within 60 days of the postmark date on your qualied application. To review the status of your application or to
ask questions, call 1-877-486-9204 or visit www.pplelectric.com/myrebate. Your right to receive this rebate will not be earned unless you purchase a qualifying
product and follow each of the steps above. This rebate cannot be combined with any other PPL Electric Utilities rebate, unless specied in writing by PPL Electric
Utilities. This rebate is available to PPL Electric Utilities customers with mailing addresses in the United States. PPL Electric Utilities is not responsible for lost, late,
damaged, illegible, misdirected or postage-due applications. Your rights to this rebate cannot be assigned or transferred without submitting a properly completed
Third Party Payment Designation Form that is approved by PPL Electric Utilities. Excessive submissions constitute fraud and may result in federal prosecution
under the U.S. mail fraud statutes (Title 18, USC 1341 and 1342). All submitted materials become property of PPL Electric Utilities and will not be returned.
ENERGY STAR
®
is a registered trademark of the U.S. Environmental Protection Agency.
How to Apply
1.
Purchase the qualifying product or service.
2.
Install the product in a property with an active meter served by PPL Electric Utilities.
3.
Mail the following to the address below:
a.
Completed application.
b.
Copy of a valid invoice. Invoice must include purchase date, product(s)
purchased showing manufacturer and model number, quantity purchased and
price paid. Circle the eligible purchase(s) on the invoice. Invoices missing any
of this information will be rejected.
Mail to: PPL Electric Utilities Rebates
3100 West Road
Bldg 3 Suite 200
East Lansing, MI 48823
Program Eligibility
–
Promotion Dates: 6/1/2020 to 5/31/2021
–
Requests must be post-marked within 90 days of
installation or June 15, 2021, whichever date is earlier.
–
IMPORTANT: Photocopy your entire submission for
your records. You could be required to mail or fax these
photocopies.
–
Funds are limited and PPL Electric Utilities reserves
the right at any time to extend, modify or terminate the
rebate program.
Signature Required
I understand PPL Electric Utilities reserves the right to audit my rebate application and if requested, I will allow PPL representatives reasonable access to verify
the installation of qualifying product(s) and potentially the removal of older products. I understand PPL Electric Utilities may provide my name and address to PPL
representatives to verify this information and I approve sending the rebate to the address I have provided above.
By providing your contact information above and signing your name below, you consent to receive email messages, phone calls and postal mail, as indicated above,
including that of a promotional nature, from PPL and its service providers on PPL’s behalf at the contact information you have provided above. You are not required
to agree to this in order to purchase property, goods or services from us. An auto-dialer and/or articial or prerecorded message may be used to make calls to you.
Your wireless carrier may charge fees for emails and calls to your mobile device. You represent that you are legally competent and have legal authority to form a
contract and provide this consent with respect to the contact information you provide and that you reside in the United States. You may not consent on behalf of
someone else or provide someone else’s contact information. You consent to receive phone calls from PPL even if your phone number is listed on the federal or
state “do not call” registry. You may elect to no longer receive promotional communications and any communications to your mobile device, by contacting us at:
PPL, Attention: Internet/Privacy Notice, c/o Customer Experience, 827 Hausman Rd., Allentown, PA, 18104; calling 1-800-342-5775; or emailing us at privacypolicy@
pplweb.com. You agree to enter into and sign this consent to receive messages electronically. Print this page using your Internet-connected computer or device
and web browser to retain a copy of your consent. You can withdraw your consent to receive this consent electronically. Mail us at PPL, Attention: Internet/Privacy
Notice, c/o Customer Experience, 827 Hausman Rd., Allentown, PA, 18104 to request a free copy of your consent, update your contact information or for other
customer service. See www.pplelectric.com/privacy-policy.aspx for our Privacy Policy.
*Signature *Date
Rebate Application Weatherization
Submit online for a faster rebate
at pplelectric.com/myrebate.
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Completed 21 July 2021

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