TRI-COUNTY Electric Cooperative, Inc.
Water Heater Rebate Form
MEMBER INFORMATION:
Member Name: _____________________________________________________________
Billing Address: ______________________________________________________________
City: ________________________ State: ____ Zip: ___________ Phone: ____________
Electric Account Number: ________________________________
Installation Information:
Manufacturer: ________________________ Model No: ____________________________
Serial Number: ______________________________________________________________
Installation Address: __________________________________________________________
Place of Purchase: ___________________________________________________________
Date of Installation: ___________________ Tank Warranty, (Years): _________________
Energy Factor Rating: ______ Rebate Amount: _________ ARI Page No: ____________
Approved By: __________________________ Date: _____________ Copy to A/P:
Rebate Qualifications: Minimum tank size is 40 gallons, Energy Factor Rating .90 or above, heating
elements must be upper and lower 4500 watt, minimum tank warranty 5 years with one year on parts
and labor.
A copy of your sales or installation receipt must accompany this request for rebate. The rebate is
for Tri-County Electric Cooperative, Inc. members only. The water heater must be installed at a
service address which is receiving electric service from Tri-County Electric Cooperative. Once the
water heater is installed, return the completed form to Tri-County Electric. A cooperative employee
may visit the location to confirm installation, please allow up to three weeks for processing of your
rebate request. All rebates will be paid by check to the member receiving service.
