NATURAL GAS WATER HEATER NATURAL GAS FURNACE

Equipment Manufacturer Equipment Manufacturer

Rebate application
For more information, please call a Model No. Model No.

PSE Energy Advisor at 1.800.562.1482.

Directions: Tank Energy Factor - Must be 0.62 or higher to qualify AFUE Rating - Must be 90 percent or higher to qualify
Fill out this application; please type or print clearly. Securely
attach legible copies of receipts or invoices that clearly show
Installing Contractor Installing Contractor
the equipment brand name and model number. Please keep
a copy for your records.
Mail to: NATURAL GAS TANKLESS WATER HEATER AIR-SOURCE HEAT PUMP
Puget Sound Energy, Energy-Efficiency Rebate Program, Equipment Manufacturer AHRI Reference No.
P.O. Box 97034, EST-10W, Bellevue, WA 98009-9734

Model No. Outdoor Unit Model No. Indoor Unit Model No.

PSE ACCOUNT NO. (10 DIGITS)

Efficiency - Must be .80 or higher to qualify Furnace Model No. (if applicable)

NAME OF PERSON THE REBATE CHECK SHOULD BE MADE PAYABLE TO

Installing Contractor Installing Contractor

DAYTIME PHONE

Puget Sound Energy will review your rebate application and determine if
FULL INSTALLATION ADDRESS your new equipment qualifies for a rebate.

By signing below you acknowledge that: Your qualifying natural gas

CITY STATE ZIP
MAILING ADDRESS (IF DIFFERENT)
CITY STATE ZIP
E-MAIL ADDRESS Yes, sign me up for PSE’s free Energy at Home e-newsletter.
equipment is installed at a residence in PSE’s natural gas service area and/
or your qualifying heat pump is installed at a residence in PSE’s electric
service area. PSE may inspect these products upon request. PSE has made
no implied or express warranties or representations with regard to these
products or energy savings from their installation. This is a tariffed service
and is subject to change or termination without prior notice.
I have read, understood and agreed to the terms and conditions of this
service and certify that the equipment described above has been purchased
and installed at the location indicated.

X
DATE INSTALLED PURCHASE PRICE SIGNATURE

Please check all that apply: DATE

New construction Rental home New heat ducts installed

Owner occupied Existing equipment replacement
Tankless water heater will be used for:
Water heating Heating
Qualifying for your incentive
• Rebate application must be submitted within one year of
equipment installation.
• Installation address must be within Puget Sound Energy’s service
area for primary energy type of qualifying equipment.
• Puget Sound Energy allows only one incentive per installed
piece of qualifying equipment.
• Should your incented equipment be replaced under warranty, or for
any other price than full cost, a second incentive will not be allowed.
• Please allow six to eight weeks to receive your incentive check.
• Equipment must be installed in an existing single-family residence.
(New construction installations are not eligible under these programs.
Contact us for more details about PSE’s builder incentives).
Submitting your rebate application
• Mail the following documents to PSE (Keep original copies for your records)
• Rebate application
• Legible copy of your sales invoice or receipt proving purchase
• AHRI Performance Certificate reference number
(Heat pump system requests only)
ENERGY STAR® qualified natural gas furnace
• $350 rebate
• Natural gas forced-air furnace must have an AFUE of
90 percent or higher
• Natural gas furnace must be the primary heat source in the home
High-efficiency heat pump system
• Tier 1 - $200 rebate • Tier 2 - $350 rebate
- 8.5 HSPF or higher - 9.0 HSPF or higher
- 14 SEER or higher - 14 SEER or higher
• Heat pump system must be AHRI performance certified
(www.ahridirectory.org/ahridirectory/hp/defaultsearch.aspx)
• Super Good Cents/ENERGY STAR qualified manufactured homes
are NOT eligible for PSE’s heat pump incentive
• Any natural gas furnace installed as back-up heating to a heat pump,
or any other system, is not eligible for the incentive
Natural gas tankless water heater
• $150 rebate
• Natural gas tankless/on-demand water heater must have an
energy factor of .80 or higher
Natural gas storage water heater
• $50 rebate
• Natural gas storage water heater must have an energy factor
of .62 or higher

4402 6/08