2024 Residential Heat Pump Electric Resistance Pre-Verification Form

ENERGY STAR® Certified Whole House Heat Pump Incentive

Qualified "Whole House" systems must meet or exceed 80% of the heat load of the home. Verification is based on two years of fuel use history review.

Member Information(Required)

First Last

Electric Account Number(Required)

Installation Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Your Phone(Required)

Your Email Address(Required)

Total conditioned square footage of the home.(Required)

https://energyaudit.nhsaves.com/squarefootage

Total linear feet of baseboard in the home.(Required)

Measure every section of baseboard in the home. Add it all up. Round your total to the nearest whole foot. This will give you your total linear feet of baseboard.

Annual Heating Fuel Usage

Is electric baseboard your primary heating source? (Check one)(Required)

Yes

Please include all other heat sources. (Check all that apply)(Required)

Oil

Kerosene

Propane

Wood Pellets

Wood

Does not apply

Contractor Information

Business Name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

Email(Required)

Equipment Information

Installation Date(Required)

Quantity of outdoor unit(s)(Required)

AHRI reference number(s)(Required)

Total tons to be installed (1 Ton = 12,000 Btu's)(Required)

Manufacturer / Brand(Required)

Outdoor model number(s)(Required)

Total estimate project cost(Required)

1. Copy of Contractor Estimate(Required)

Max. file size: 1 GB.

Must contain Install location, Make and Model Number(s), Contractor Information (Business Name, Address, Phone Email), and Total Project Cost.

2. Photo documentation of all baseboard in the home(Required)

Max. file size: 1 GB.

3. Rough Floor Plan(Required)

Max. file size: 1 GB.

Please include all rooms in the home. (Closets not required) Location of all baseboard. Location of all (new to be installed) interior heads. Location of outside unit(s). Note: Floor plan can be hand drawn and does not have to be to scale.

Date(Required)