Step 1 of 2 0% Please fill out each section and attach the requested documentation. Any questions can be directed to member services (208) 743-1501. Member / Customer InformationName* First Last CPC Account Number*Service Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Mailing Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone*Email* Heat Pump Rebate Information All installations must be performed by a certified installer/contractor, and meet all requirements.Heat Pump Geothermal Heat Pump ‐ $3000 International Ground Source Heat Pump Association (IGSHPA) and Performance Tested Comfort Systems (PTCS); New systems Electric Furnace to Heat Pump ‐ $1400 / $1600 Variable Speed — 9 Heating Seasonal Performance Factor (HSPF)/14 Seasonal Energy Efficiency Ratio (SEER) ; PTCS; Existing Homes Only Heat Pump Upgrade or Fuel Switching‐ $500 / $700 Variable Speed — 9 HSPF/14 SEER; PTCS; New or Existing Homes Home InformationYear BuiltEstimated Sq. FtManufactured Yes No Number of Sections 1 2 3 Previous Systems(Check all that apply) Electric Forced‐Air Furnace Zonal Electric (baseboard, etc.) Air Conditioning Lower Efficiency Heat Pump Other Other:I want my rebate:As a credit on my accountIn the form of a checkRequired Paperwork for Processing Invoices / Receipts with model numbers AHRI certificate Proof of previous system (pictures, if requested) PTCS form and calculation Paperwork* Drop files here or AgreementApplicant Consent* I hereby request an incentive for the above listed item(s) and agree to the BPA terms and conditions. I understand that final approval will be determined by Clearwater Power Company. I hereby verify the above information to be true and complete. 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.Applicant Electronic Signature (Full Name)*
