Homeowner Name(Required) First Last Mailing Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Site Address(Required) Same as Mailing Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code REC Account Number(Required) Requirements and Specifications This measure is a conversion from an electric forced-air furnace to a high-efficiency ducted air-source heat pump Air Source Heat Pump must be AHRI-tested and certified; manufacturer claims of “equivalent to AHRI-certified equipment” will not be accepted. Rated as having a HSPF2 and a SEER2 efficiency rating that meets federal minimum standards according to the AHRI certificate. HSPF2 and SEER2 apply to units manufactured after January 1, 2023 based on DOE’s change to the national standard testing methodology. If a unit was manufactured before January 1, 2023, it must meet the current federal minimum efficiency standard for HSPF and SEER per the AHRI certificate. Applicable home types with whole-home centrally ducted systems: Existing construction single-family; Existing manufactured homes (including new manufactured homes once on site for occupancy). Homes with less than 4,500 square feet of heated floor area may qualify for only one heat pump payment. This may be one ducted or one ductless heat pump (DHP) but not both. There are two exceptions to this rule: • When the home has two entirely separate duct systems, the home is eligible for two ASHP payments but no more, even if there are more than two duct systems; • When the home’s ductwork has not been extended to an addition, a DHP may be installed to service the area of the home that does not contain ducts. In this scenario, the home may be eligible for a ducted ASHP and one DHP payment. Homes with greater than 4,500 square feet of heated floor area qualify for up to two heat pump measures and no more provided all other program requirements are met.Manufacturer(Required) Model Number(Required) Heat Pump Size (in Tons)(Required) Installed HSPF2(Required) Installed SEER2(Required) Installer name:(Required) Building Size & TypeTotal Conditioned Square Feet(Required) New Construction?(Required) Yes No Date System Energized(Required) Month Day Year Existing Heat Source(Required) Do you have a backup heating source?(Required) Yes No Back-up Heating SystemHeating System Replaced(Required) Strip Heat in Plenum (KiloWatts)(Required) Strip Heat in Plenum (Btu)(Required) HiddenSubmeter Installed Yes No HiddenDate Submeter Installed(Required) MM slash DD slash YYYY Information Required to Complete Installation Agreement for IncentivesA copy of the sales invoice and the AHRI certificate must be included with this agreement.Upload additional material(Required) Drop files here or Select files Max. file size: 499 MB. Consent(Required)I have included a copy of the sales invoice which shows purchase date and installed cost. I have included a copy of the AHRI certificate for the ASHP installed. Member understands that changes to the Air Source system may disqualify it from program participation. Failure to comply with this Agreement will disqualify member from receiving program incentives. Member understands, it is the installer’s responsibility to install the system according to all applicable codes and that Ravalli Electric Co-op is free from liability arising from the installation and/or operation of the system. Ravalli Electric Co-op reserves the right to terminate the program and/or modify the program and incentive levels without notice. Member is responsible for checking with Ravalli Electric Co-op to determine whether the program has been changed or is still in effect. 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 Electronic Signature (Full Name)(Required) PhoneThis field is for validation purposes and should be left unchanged.
