I&M CUSTOMER INFORMATION

State:

855-231-5274 ELECTRICIDEAS.COM

First Name: (Account holder on record) Last Name: (Account holder on record) I&M Account No. :

Installation Address: City: Zip Code:

Email:

(Your email address will be used only for communications regarding energy efficiency programs.)

Date Installed: Contractor Name:

What type of residence do you live in?

Single Family 2-4 units Other:

Is this system installed as part of a new home construction project?

Yes No

Is natural gas available at this residence?

Yes No Not Sure

Does the new unit replace the same type of equipment?

Yes No

What is the fuel type of the equipment being replaced?

Electric Baseboard/Ceiling Cable Heat Pump Gas Other:

TERMS AND CONDITIONSCustomer eligibility: Offer is valid for Indiana Michigan Power Indiana residential customers served on a residential billing tariff. Residential rebates are available for residential homes or multifamily dwellings of 2 to 4 units. Equipment must be installed in a property owned by the applicant, or the applicant must have received permission from the property owner to install the equipment. Rebate payments will be made to the I&M account holder. I&M program rebates are available for qualifying equipment installed in existing properties (Indiana) and/or new construction (Michigan).Equipment eligibility: Offer is valid for the purchase and installation of equipment completed by December 13, 2019. For a current list of qualifying equipment, visit ElectricIdeas.com or call 855-231-5274. Resale equipment, new parts installed in existing equipment, or equipment that is leased, rebuilt, rented, received from insurance claims, received from a warranty, or won as a prize do not qualify. Equipment must be installed conforming to all applicable building, local, state, and federal codes, standards, ordinances and regulations, and manufacturer’s specifications. Equipment must be installed and operational prior to submittal of this application. Self-installation: Customers who self-install qualifying equipment may be eligible, if the installation meets all program requirements. By submitting this application, the customer certifies that they have installed the product to meet appropriate codes and manufacturer specifications and have met all other program requirements. Application eligibility: Applications must be completed in full and accompanied by the required itemized invoices or receipts. Applications must be postmarked or emailed within 60 days of purchase of the equipment and received by December 13, 2019 to be considered eligible for rebates. Funds are limited and applications are processed on a first-come, first served basis. The Program is subject to change and may end without prior notice. Rebate payment: I&M rebate may not exceed the total purchase price of the eligible equipment. The only costs eligible for rebates are: materials and equipment. Customers cannot apply for an energy efficiency rebate and a new home construction rebate on the same equipment or product. I&M will only pay one rebate for each qualifying product installed.Allow up to six weeks to receive your rebate. Incomplete applications cannot be processed. Failure to complete the rebate application in full and provide the required supporting documentation will either delay the payment process or result in your application being denied. Receipt of an application does not guarantee payment of a rebate. The Program is not responsible for items (e.g. application,

supporting documentation, rebate checks) lost or damaged in the mail.Verification: I&M reserves the right to verify sales receipts and/or installations of equipment, products and services before issuing rebates. All equipment installations are subject to verification by the Program to ensure the equipment is properly installed and operating. An inspection may be conducted to verify installations. By submitting this rebate application, the applicant agrees to participate in any audit requested by I&M as it pertains to the rebate program. Program modifi cations: I&M reserves the right to alter or discontinue rebate offers at any time without notice.Disclaimer: I&M does not guarantee that energy efficient equipment purchased and installed or services provided through this program will result in energy and cost savings. I&M reserves the right to deny or limit any rebate request. In addition, no warranties on product or service installations are provided by I&M, nor does the Program warrant, guarantee or endorse the energy efficiency services provided by any specific contractor participating in the Program. I&M, the Program Administrator, and the Program Implementer, their respective affiliates, subsidiaries, parent companies, officers, directors, agents and employees disclaim any and all liability, loss or damages, and make no guarantees related to: participation in the Program, including use or installation of the equipment; loss or delay of rebate check(s) in the mail; and any taxes that may be imposed as a result of participation in the Program. Please allow up to six weeks to receive your rebate.Indemnification: Signatory(ies) and applicant(s) shall hold harmless and indemnify I&M, the Program Administrator, and the Program Implementer, their respective affi liates, subsidiaries, parent companies, officers, directors, agents and employees against any and all losses, damages, expense, fees, costs and liability arising from any design, consulting, product, system, equipment or appliance or any one claim, in connection with the Program.Representation: Making false statements on any I&M rebate application is punishable by law. Any and all funds determined, in I&M’s sole discretion, to have been acquired on the basis of fraudulent or misrepresented information must be returned to the Program. I&M may refuse payment and participation if the signatory(ies), applicant(s), customer(s), or contractor(s) violate program rules or procedures.Taxes: You are urged to consult your tax advisor concerning the taxability of rebates. I&M is not responsible for any taxes that may be imposed on an individual or business as a result of your receipt of this rebate.

By signing this application, I agree to the terms and conditions of this document. I understand Indiana Michigan Power reserves the right to audit my rebate application and, if requested, I will allow an Indiana Michigan Power representative reasonable access to verify the installation of qualifying products.

Customer Signature: Date:

Enter rebate online at ElectricIdeas.com/Products or mail this completed application and other required documents to the address below.

I&M Home Energy Products ProgramPO Box 60Fort Wayne, IN 46801

Don’t forget to include:• Completed rebate application• Receipt from installing contractor that includes date of purchase and is marked “paid in full” or zero balance• An AHRI* certifi cate or manufacturer’s specification sheet• Please do not send this form with your utility bill payment.

Payment will be made to the account holder at the address on record.

Don’t

forget:

HVAC EQUIPMENT REBATE APPLICATIONIndiana & Michigan

Contractor Email:

Home Phone:

( )Cell Phone:

( )

Contractor Phone Number:

( )

The Home Energy Products HVAC Program provides rebates for the installation of high-efficiency HVAC equipment to residential customers of Indiana Michigan Power (I&M). This equipment must meet all program requirements.

This application and the documents noted below must be submitted within 60 days of equipment purchase and received by December 13, 2019 to process this rebate request.1) A sales receipt indicating “paid in full” or zero balance from the installing contractor, and

2) An AHRI* certificate or manufacturer’s specification sheet including unit model number, capacity and efficiency performance ratings.

All minimum efficiency ratings must be met to qualify for a rebate.

SEER ≥ 17 and HSPF ≥ 9.5 $50 1 ton $100 2  ton $150 ≥ 3  ton

Equipment Rebate Minimum Manufacturer Model No. Serial No. (SN#) Amount Requirement Certificate No. (AHRI#)

SEER – Seasonal Energy Efficiency Ratio EER – Energy Efficiency Ratio HSPF – Heating Season Performance Factor

Wi-fi Programmable Thermostat for Electric Heat with Central AC (2 units maximum)

Wi-fi Programmable Thermostat for Non-Electric Heat with Central AC (2 units maximum)

N/A

Did you install a furnace with either an air source heat pump or central air conditioner? Yes No, furnace is existing Furnace Model Number:

If your AHRI* reference number includes a furnace, please provide the furnace model number as this information is required to qualify for the heat pump or central air conditioner rebate.

* The Air-Conditioning, Heating and Refrigeration Institute (AHRI) maintains a directory of certified product performance for HVAC equipment. To obtain a copy of the AHRI certificate, certificate number or products that meet the program’s minimum efficiency requirements, please visit http://www.ahridirectory.org/ahridirectory/pages/home.aspx

HEA-0119 855-231-5274 ELECTRICIDEAS.COM

Ductless Heat Pump Replacement of Heat Pump (2 units maximum)

Note: 1/4 tons round down, 1/2 tons round up

50% of purchase

price up to $100

$25 N/A N/A

SEER ≥ 19 and HSPF ≥ 9.5

SEER ≥ 21 and HSPF ≥ 10

SEER ≥ 23 and HSPF ≥ 10

SEER ≥ 17 and HSPF ≥ 9.5

SEER ≥ 19 and HSPF ≥ 9.5

SEER ≥ 21 and HSPF ≥ 10

SEER ≥ 23 and HSPF ≥ 10

Ductless Heat Pump Displacement of Electric Resistance Heat (2 units maximum)

Note: 1/4 tons round down, 1/2 tons round up

$110 1  ton $220 2  ton $330 ≥ 3  ton

$135 1 ton $270 2  ton $405 ≥ 3  ton

$150 1 ton $300 2  ton $450 ≥ 3  ton

$150 1 ton $300 2  ton $450 ≥ 3  ton

$200 1  ton $400 2  ton $600 ≥ 3  ton

$270 1 ton $540 2  ton $810 ≥ 3  ton

$285 1 ton $570 2  ton $855 ≥ 3  ton

HVAC Energy Efficient Systems

Equipment Rebate Minimum Efficiency *

Manufacturer Condenser Model No. Condenser Serial No. Coil Model No. AHRI

Amount Requirement Outside Unit Outside Unit Inside Unit Certificate No.

$300

Air Source Heat Pump Upgrade (Traditional Ducted Systems) (2 units maximum)

SEER ≥ 15 and HSPF ≥ 8.2

$400

$500

SEER ≥ 16 and HSPF ≥ 8.7

SEER ≥ 17 and HSPF ≥ 9.2

SEER ≥ 16

HVAC EQUIPMENT REBATE APPLICATION Indiana & Michigan

Incomplete information will delay or disqualify your rebate.

First Name: (Account holder on record) Last Name: (Account holder on record)

Central Air Conditioner Upgrade (2 units maximum)

Electronically Commutated Motor (ECM) (2 units maximum)

ECM can be a retrofit or part of a new HVAC system. ECM must replace non-ECM furnace or HP Air Handler motor.

$100

$300

$600 SEER 18 and above

SN#

AHRI#

N/A