EnergyUnited Member Information

Name *

First

Last

EnergyUnited Account # *

Member Email Address *

Address *

Street Address

Address Line 2

City

State / Province / Region

Zip/Postal/Code

Country

Phone *

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HVAC Installer Information

HVAC Installer *

HVAC Installer Email Address *

HVAC Installer License # *

HVAC Installer Address *

Street Address

Address Line 2

City

State / Province / Region

Zip/Postal/Code

Country

HVAC Installer Phone *

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Equipment Installed

Outdoor Model # *

Outdoor Serial # *

Indoor Model # *

Indoor Serial # *

Manufacturer / Brand of Equipment *

Tonnage *

AHRI Certification # (rebate $ amount based on AHRI data) *

Manufacturer's Rating of SEER *

Manufacturer's Rating of HSPF *

Inspection # *

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Attach documents below. Must be in PDF format.

Copy of Sales Invoice must be attached for processing of rebate. *

Click Here to Upload Your File

Copy of AHRI Certificate must be attached for processing of rebate.* *

Click Here to Upload Your File

Copy of County Inspection must be attached for processing of rebate. *

Click Here to Upload Your File