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VISIT NH Broadband
Residential Heat Pump Rebate
Rebate Application
Heatpump
Member Information
Name
*
First
Last
Installation Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
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Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
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Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Do you have a different mailing address?
*
Yes
No
Mailing Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
*
Email
*
Electric Account Number
*
where equipment was installed
How did you first learn about the heat pump rebates?
Advertisement inserted in my bill
Button up Workshop
Contractor
Email
Friend/Colleague
Internet search (Google, Bing, Yahoo)
NHEC Website
NHSaves
Newsletter
Newspaper
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Select one
Telephone Town Hall
Other
Existing heating fuel type
*
Oil
Propane
Electric
Other
New Construction
Existing heating system type
*
Furnace
Boiler
Heat Pump
Other
New Construction
Is the heat pump replacing existing air conditioning units
*
Yes
No
Capacity of the AC system being replaced
*
in BtU’s
Contractor Information
Business name
*
Phone
*
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Fax Number
Email
Equipment Information
Only ENERGY STAR® Certified heat pumps meeting the minimum efficiency ratings outlined in the
incentives table
will be eligible for a rebate.
EnergyStar Heat Pump/Mini Split Systems
Please select your heat pump type
Air Source Heat Pump
A/C Only Heat Pump
Install date
*
MM slash DD slash YYYY
Quantity
*
AHRI Ref#
*
AHRI Cooling Capacity
*
Number of Tons (1 Ton = 12,000/BTU/h)
*
Manufacturer/Brand
*
Outdoor Model Number
*
Total Cost
*
Rebate Amount
*
Heating Controls
Equipment
WI-FI Thermostat (for Heat Pumps Only)**
**WI-FI connections must be enabled. Rebate not to exceed purchase price. Limit one (1) thermostat per Heat Pump zone installed per account. Qualifying equipment must be installed between January 1, 2024 – December 31, 2024 to be eligible for a rebate.
Install date
MM slash DD slash YYYY
Quantity
Manufacturer/Brand
Model Number
Total Cost
Rebate Amount
For new Heat Pump and Geothermal systems that offset 80% of the home's total heating load, there is an additional $250 per ton incentive available. Submit with your application: 2 years of heating fuel usage, Type of fuel, Existing heating system equipment efficiency %. Are you applying for the 80% bonus incentive?
*
Yes
No
For homes that have participated in the Home Performance w/ ENERGY STAR program in the last 12 months there is an additional $250 per ton incentive available. Are you applying for the Home Performance w/ ENERGY STAR bonus incentive?
*
Yes
No
Please attach copies of dated invoices with equipment make and model specifications.
*
Drop files here or
Select files
Accepted file types: pdf, doc, docx, jpg, png, xls, xlsx, Max. file size: 16 MB.
Sign Here
Download Eligible Equipment & Incentives, and read Terms and Conditions
I have read and understand the terms and conditions. I certify that the information I have provided is true and correct and the products(s) and equipment for which I am requesting an incentive meets the requirements in this application.
*
Yes
Customer Digital Signature
*
Date
*
MM slash DD slash YYYY