Instructions: Complete this form and submit it to the serving electric utility. Retrofits are eligible for incentives. New construction applications are not eligible. BUSINESS AND SITE INFORMATION Customer Name Installation Address (Street, City, State, Zip) Customer Phone Number EXISTING EQUIPMENT INFORMATION Existing Equipment Information Was area conditioned by heat pump previously Yes heated with electric resistance heat? No (If not eligible for incentives) “No”, project is NEW EQUIPMENT INFORMATION New Equipment Information Heat Pump 1 Heat Pump 2 Heat Pump 3 The heat pump Heat Pump installed meets BPA’s Yes Yes Yes Tier 1 or Tier 2 Specification available at: No (If No (If No (If not not not “No”, project is “No”, project is “No”, project is eligible for incentives) eligible for incentives) eligible for incentives) Yes Yes Yes The heat pump installed is an air-to-air heat pump No (If is not No (If is not No (If is not “No”, project “No”, project “No”, project system, 20 tons or less of cooling capacity eligible for incentives) eligible for incentives) eligible for incentives) Heat pump manufacturer Heat pump model Tons of cooling capacity INSTALLER INFORMATION Company Name Installer Signature Total Installed Cost (before rebate) including equipment, labor, and purchase date. Please include invoice with this project form. Date By signing this form, I confirm that the above information is correct to the best of my knowledge.
Instructions: Complete this form and submit it to the serving electric utility. Retrofits are eligible for incentives. New construction applications are not eligible. BUSINESS AND SITE INFORMATION Customer Name Installation Address (Street, City, State, Zip) Customer Phone Number EXISTING EQUIPMENT INFORMATION Existing Equipment Information Was area conditioned by heat pump previously heated with electric resistance heat? Yes No (If “No”, project is not eligible for incentives) NEW EQUIPMENT INFORMATION New Equipment Information Heat Pump 1 Heat Pump 2 Heat Pump 3 The heat pump installed meets BPA’s Heat Pump Tier 1 or Tier 2 Specification available at: Yes No (If “No”, project is not eligible for incentives) Yes No (If “No”, project is not eligible for incentives) Yes No (If “No”, project is not eligible for incentives) The heat pump installed is an air-to-air heat pump system, 20 tons or less of cooling capacity Yes No (If “No”, project is not eligible for incentives) Yes No (If “No”, project is not eligible for incentives) Yes No (If “No”, project is not eligible for incentives) Heat pump manufacturer Heat pump model Tons of cooling capacity INSTALLER INFORMATION Company Name Installer Signature Total Installed Cost (before rebate) including equipment, labor, and purchase date. Please include invoice with this project form. Date By signing this form, I confirm that the above information is correct to the best of my knowledge.
Heat%20Pump%20Conversion%20Project%20Information%20Form.docx