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 Requirements and Specifications These measures are available for existing single-family homes, manufactured homes, and multifamily homes. They are not available for new construction. A maximum of one unitary HPWH measure may be claimed per home. Accessory dwelling units with separate plumbing systems qualify for this measure even if they are on the same electrical meter. Unitary HPWHs must be listed on BPA’s HPWH Qualified Products List.Home Type(Required) Existing Site Built New Construction Site Built Manufactured Year Built(Required) Number of Water Heaters in Home Before This Installation(Required) Number of Water Heaters in Home After This Installation(Required) Number of Occupants(Required) Information About the Water Heater Being ReplacedFuel(Required) Electric Gas Propane Age (years)(Required) Size (gallons)(Required) Installation InformationManufacturer(Required) Model(Required) Size (gallons)(Required) Installation Date (mm/dd/yyyy)(Required) MM slash DD slash YYYY Where was this water heater purchased?(Required) Installer Retailer Online Other Total Installed Cost (before rebates)(Required) Installation Location(Required) Interior Heated Location Unheated Location Specific Installation Location(Required) Garage Basement Other Ducted Installation(Required) Yes No Carbon Monoxide Monitor Location(Required) Ducted out of conditioned space?(Required) Yes No Length of intake duct (feet)(Required) Length of exhaust duct (feet)(Required) Upload a copy of the purchase receipt or installer's invoice(Required)Max. file size: 499 MB.Consent(Required)This form must be signed by the person whose name appears on the electric utility account. Energy Information Release: The undersigned utility customer requests and authorizes the specified utility to release billing and usage information for the account listed below to Bonneville Power Administration (BPA). With this authorization, BPA can request billing information for up to two years pre installation and two years post installation. The utility customer also hereby releases the utility company from any and all liability arising from or connected with providing this information. Ravalli Electric Cooperative reserves the right to inspect pre-existing equipment (if applicable) prior to installation and energy efficient measures installed under this program. Ravalli Electric Cooperative reserves the right to terminate the Program and/or modify the incentive/ rebate levels without notice. The Member is responsible for checking with the Co-op to determine whether the Program has been changed or is still in effect. Missing or incorrect information may delay the processing of the rebate. Failure to comply with this Agreement will disqualify the Member from receiving program incentives. This Agreement does not guarantee that the equipment will meet the criteria necessary for program incentives. 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 Account Number(Required) Applicant Electronic Signature (Full Name)(Required) NameThis field is for validation purposes and should be left unchanged.
