Instructions: Complete this form and submit it to the serving electric utility. Retrofits and new installations are eligible for incentives. BUSINESS AND SITE INFORMATION Customer Name Installation Address (Street, City, State, Zip) Customer Phone Number EXISTING EQUIPMENT INFORMATION Existing Equipment Information Control 1 Control 2 Control 3 New or existing vehicle engine block heater does Yes Yes Yes not have temperature or heater controls except for No (If project is not No (If project is not No (If project is not “No”, “No”, “No”, eligible for incentives) eligible for incentives) eligible for incentives) manual control Yes Yes Yes Is installed in a vehicle No (If project is not No (If project is not No (If project is not “No”, “No”, “No”, eligible for incentives) eligible for incentives) eligible for incentives) NEW EQUIPMENT INFORMATION Vehicle Engine Heater Control Information Control 1 Control 2 Control 3 The vehicle engine block heater control is Yes Yes Yes using 1) a dedicated controlled outlet or 2) No (If project is not No (If project is not No (If project is not “No”, “No”, “No”, installed directly on the engine block heater eligible for incentives) eligible for incentives) eligible for incentives) The vehicle engine block heater control keeps block heaters off when the ambient air temperature is Yes Yes Yes above the temperature setting, and delivers only as No (If No (If No (If project is not project is not project is not “No”, “No”, “No”, eligible for incentives) eligible for incentives) eligible for incentives) much heat as necessary when the temperature drops below the setting The vehicle engine block heater control is not Yes Yes Yes portable and cannot be unplugged (e.g. extension No (If project is not No (If project is not No (If project is not “No”, “No”, “No”, cord model) eligible for incentives) eligible for incentives) eligible for incentives) Manufacturer Model Number of control INSTALLER INFORMATION Company Name Installer Signature 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 and new installations are eligible for incentives. BUSINESS AND SITE INFORMATION Customer Name Installation Address (Street, City, State, Zip) Customer Phone Number EXISTING EQUIPMENT INFORMATION Existing Equipment Information Control 1 Control 2 Control 3 New or existing vehicle engine block heater does not have temperature or heater controls except for manual control 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) Is installed in a vehicle 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) NEW EQUIPMENT INFORMATION Vehicle Engine Heater Control Information Control 1 Control 2 Control 3 The vehicle engine block heater control is using 1) a dedicated controlled outlet or 2) installed directly on the engine block heater 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 vehicle engine block heater control keeps block heaters off when the ambient air temperature is above the temperature setting, and delivers only as much heat as necessary when the temperature drops below the setting 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 vehicle engine block heater control is not portable and cannot be unplugged (e.g. extension cord model) 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) Manufacturer Model Number of control INSTALLER INFORMATION Company Name Installer Signature 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.
Vehicle%20Engine%20Block%20Heater%20Control%20Project%20Information%20Form.docx