High Efficiency Water Heater Upgrade Incentive Form
Applicant Information
Full Name
Address
City
State
ZIP Code
Phone Number
Email
Installation Details
Installation Date
Installer/Contractor Name
Installer Contact Number
New Water Heater Information
Brand
Model Number
Serial Number
Heater Type
Tankless
Storage (Tank)
Heat Pump
Other
Energy Factor (EF) / UEF
Capacity (gallons)
Existing Water Heater Information
Existing Heater Type
Tankless
Storage (Tank)
Heat Pump
Other
Existing Fuel Type
Electric
Gas
Other
Capacity (gallons)
Supporting Documents
Attach Invoice
Attach Photo of Installed Water Heater
Additional Notes