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Gulf Power EarthCents Rewards Residential Incentive Application Heat Pump Water Heater

To ensure eligibility for programs please visit Completely fill out each section; incomplete forms will not be processed. Include the following: 1. completed application form 2. a copy of your itemized sales receipt, including labor if applicable, marked paid 3. a copy of manufacturers documentation showing energy factor Mail to: Gulf Power EarthCents Rewards, One Energy Place, Pensacola, FL 32520-0950. Or email to: Make a copy of this application for your records. For more information, call 1-877-655-4001. Gulf Power Account Number: Name (on account):___________________________________ Email: ______________________________________ Service Address: _____________________________________ City: ______________ State: ___ Daytime Phone: ___________________ Incentive paid to: Name ______________________________ Email: ______________________________________ Mailing Address: ___________________________________ Heat Pump Water Heater ($700)
Equipment purchased (i.e. HPWH):__________________________ Date Purchased: _________________ _____________________ Manufacturer/Brand __________________ Model # Purchased from: _____________________ Date Installed: _________________ ___________________ Energy Factor

Zip: __________

City: ________________ State: ___Zip: _________

Terms and Conditions: Must be a Gulf Power residential customer. Must submit application within 60 days of installation date. Product must be new and purchased on or after June 1, 2011, during the effective dates of the program. Must not be pre-owned or leased. Incentive amount not to exceed total project cost. Allow 6-8 weeks for incentive.
How did you hear about this program? Salesperson Radio/TV Newspaper Referral Gulf Power bill insert Gulf Power website Other: __________________________________________

I hereby certify that I am a Gulf Power residential customer, all information on this form is accurate and I have read and accept the Program Requirements listed at ; I acknowledge that Gulf Power will make the final determination of any incentive that I will receive and may verify the information provided, including verification of the product(s) installed at the service address. Program is subject to change or cancellation without notice.

______________________________________________________ Customer Signature

_________________________________ Date

I wish to donate my entire incentive for products listed above on this form to Project Share, an energy assistance program in which Gulf Power partners with the Salvation Army to help those in need.

Residential Heat Pump Water Heater Program The objective of this program is to encourage customers to replace existing older or malfunctioning water heaters with the most efficient water heating equipment available in order to reduce energy use associated with domestic water heating. In addition, it is the intent of this program to influence the initial water heating purchase decisions of customers who are building or considering the construction of a new home. Eligibility: This program is available to residential Gulf Power customers in new or existing single-family and individual units within multi-family buildings as well as permanently anchored manufactured homes that are metered by Gulf Power within the companys service territory. In the event an eligible installation is being done prior to a customer owning a residence served by Gulf Power, or upon an agreement between the customer and the licensed home builder constructing that residence, the builder will be eligible for the incentive. Qualifying installations include both air source and water source Heat Pump Water Heaters with an Energy Factor EF greater than or equal to 2.0. Itemized Paid Sales Receipt as Proof of Purchase: Participating customers must submit to Gulf Power a completed incentive application form no more than 60 days after product/equipment installation. This application must be submitted with an itemized list of the new qualifying product/equipment purchased. The list must indicate date of purchase, and qualifying information about the product/equipment such as the size, type, make, model, and manufacturers energy efficiency specifications. Incentive: The total amount of this incentive shall not exceed $700 per eligible Integrated unit or $350 for eligible Add-On unit. Incentive will be paid in the form of a check.