Wheatland Electric Heat Pump Rebate Fillable Form

Please make sure to complete the application and attach an AHRI certificate and a dated installation invoice.

Heat Pump Rebate

Application must be submitted within 60 days of installation. Incomplete applications will not be accepted. For questions, contact Caitlin Moser, member services coordinator, at 620-874-4505 or rebates@weci.net..

MEMBER INFORMATION

Name

Email

Phone

Physical Address

Mailing Address

City/Town

State/Province

ZIP/Postal Code

Wheatland Account Number

Personal Residence

Landlord Account

Rental Property

CONTRACTOR

Contact Name

Company

Email

Phone

Address

City/Town

State/Province

ZIP/Postal Code

EIN #

EQUIPMENT INFORMATION

New Unit Type

Installation Date

Heat Pump Model

Heat Pump Serial #

Condenser Model

Condenser Serial #

Evaporator Model #

Evaporator Serial #

SEER

HSPF

Tonage

Back Up Heating System

Invoice

Please attach a copy of the dated receipt or contractor invoice that details all installed equipment information, including brand, model #, and serial #.
One file only.
20 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, svg.

APPLICANT ACKNOWLEDGEMENT

Member Signature

Please use your mouse (or finger for touch screens) to sign. By signing your name in this box, the Member affirms that the information reflected here is accurate to the best of his or her knowledge and that falsification or reporting of incorrect information on this form is grounds for denial of the rebate.