Homeowner Name(Required) 第一个 最后的 Mailing Address(Required) Street Address Address Line 2 城市 状态 阿拉巴马州阿拉斯加American Samoa亚利桑那州阿肯色州California科罗拉多州Connecticut特拉华州District of Columbia佛罗里达乔治亚州关岛夏威夷爱达荷州伊利诺斯州印第安纳州爱荷华州堪萨斯肯塔基州路易斯安那州缅因州马里兰Massachusetts密歇根明尼苏达州Mississippi密苏里州蒙大拿内布拉斯加州内华达New HampshireNew JerseyNew Mexico纽约North CarolinaNorth DakotaNorthern Mariana Islands俄亥俄州俄克拉何马州俄勒冈州PennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth Dakota田纳西州德州犹他州U.S. Virgin Islands佛蒙特州维吉尼亚州WashingtonWest 维吉尼亚州威斯康辛州怀俄明Armed Forces AmericasArmed Forces EuropeArmed Forces Pacific 邮政编码 Site Address(Required) Same as Mailing Address Street Address Address Line 2 城市 状态 阿拉巴马州阿拉斯加American Samoa亚利桑那州阿肯色州California科罗拉多州Connecticut特拉华州District of Columbia佛罗里达乔治亚州关岛夏威夷爱达荷州伊利诺斯州印第安纳州爱荷华州堪萨斯肯塔基州路易斯安那州缅因州马里兰Massachusetts密歇根明尼苏达州Mississippi密苏里州蒙大拿内布拉斯加州内华达New HampshireNew JerseyNew Mexico纽约North CarolinaNorth DakotaNorthern Mariana Islands俄亥俄州俄克拉何马州俄勒冈州PennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth Dakota田纳西州德州犹他州U.S. Virgin Islands佛蒙特州维吉尼亚州WashingtonWest 维吉尼亚州威斯康辛州怀俄明Armed Forces AmericasArmed Forces EuropeArmed Forces Pacific 邮政编码 Requirements and Specifications These measures are available for existing single-family homes, manufactured homes, and multifamily homes. They are not available for new construction. A maximum of one unitary HPWH measure may be claimed per home. Accessory dwelling units with separate plumbing systems qualify for this measure even if they are on the same electrical meter. Unitary HPWHs must be listed on BPA’s HPWH Qualified Products List.家庭类型(Required) Existing Site Built New Construction Site Built Manufactured Year Built(Required) Number of Water Heaters in Home Before This Installation(Required) Number of Water Heaters in Home After This Installation(Required) Number of Occupants(Required) Information About the Water Heater Being Replaced燃料(Required) 电 气体 丙烷 Age (years)(Required) Size (gallons)(Required) Installation InformationManufacturer(Required) 模型(Required) Size (gallons)(Required) Installation Date (mm/dd/yyyy)(Required) MM slash DD slash YYYY Where was this water heater purchased?(Required) 安装程序 零售商 在线 其他 Total Installed Cost (before rebates)(Required) Installation Location(Required) Interior Heated Location Unheated Location Specific Installation Location(Required) 车库 地下室 其他 Ducted Installation(Required) 是的 No Carbon Monoxide Monitor Location(Required) Ducted out of conditioned space?(Required) 是的 No Length of intake duct (feet)(Required) Length of exhaust duct (feet)(Required) Upload a copy of the purchase receipt or installer's invoice(Required)马克斯. file size: 499 MB.同意(Required)This form must be signed by the person whose name appears on the electric utility account. Energy Information Release: The undersigned utility customer requests and authorizes the specified utility to release billing and usage information for the account listed below to Bonneville Power Administration (BPA). With this authorization, BPA can request billing information for up to two years pre installation and two years post installation. The utility customer also hereby releases the utility company from any and all liability arising from or connected with providing this information. Ravalli 电 Cooperative reserves the right to inspect pre-existing equipment (if applicable) prior to installation and energy efficient measures installed under this program. Ravalli 电 Cooperative reserves the right to terminate the Program and/or modify the incentive/ rebate levels without notice. The Member is responsible for checking with the Co-op to determine whether the Program has been changed or is still in effect. Missing or incorrect information may delay the processing of the rebate. Failure to comply with this Agreement will disqualify the Member from receiving program incentives. This Agreement does not guarantee that the equipment will meet the criteria necessary for program incentives. I hereby verify the information to be true and complete and agree to the terms and conditions. I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today’s date and authorized by me as if I had signed my signature.Member Account Number(Required) Applicant Electronic Signature (Full Name)(Required) 评论This field is for validation purposes and should be left unchanged.