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350 Wedcor Avenue Wabash Indiana 46992 (260) 563-2146 or (800) 563-2146

Water Heater Rebate Program Agreement

Name: Account #:

Phone #: Date Installed:

Installation Address: Map Location:

Reason for Replacement : new construction non-electric older than 5 yrs non-working

In consideration for Wabash County REMC giving a rebate (bill credit) for the purchase and installation of an energy efficient
electric water heater, the undersigned residential member agrees to abide by all the terms and conditions of the agreement.
• Install an energy efficient electric water heater on Wabash County REMC lines.
• Water Heater must have an energy factor of .90 or better.
• Provide proof of purchase of energy efficient electric water heater.
*A copy of the members signed contract or paid receipt must accompany this agreement to be considered for
the water heater rebate. Member has 90 days from date of purchase to apply for the Wabash County REMC
Water Heater Rebate.
• Member has not received a Wabash County REMC Water Heater Rebate in the past 5 years.
• Must be installing a new electric water heater in a new full-time residence (see program outline for eligibility) OR
replacing a non-electric water heater OR replacing an existing water heater that is more than 5 years old or non-
• In exchange for the rebate credit the member will receive from Wabash County REMC, the member agrees to allow
Wabash County REMC to install a load management switch on the water heater at a future time, if warranted. Failure
to do so will result in the rebate being rescinded, and a charge of the rebate will be made on the next billing
statement. If a new water heater replaces one that had a load management switch installed on it, member agrees to
notify Wabash County REMC when the new water heater is installed so that the switch can be transferred to the new
water heater.
Water Heater Information
Manufacturer Energy Factor Model # Serial # Gallon

I certify the information provided is accurate.

Signature__________________________________________ Date____________
*Rebate approval may be subject to on site verification upon discretion of Wabash County REMC.

For Wabash County REMC use only:

Approved: Y or N Credit Amount: Verified By: Date Applied:
Switch #: Switch Install Date: Installed by:

Form: 112 Revised: 2/1/10