Energy Efficient Electric Equipment

$$ REBATES $$
To apply for your rebate - Please complete and
CUSTOMER INFORMATION submit this form to your local Black Hills Power
Name: _________________________________ office, along with “PROOF OF PURCHASE” to
Service Address: _________________________ begin processing your rebate. Please provide all
Account #: ______________________________ pertinent information on this form so it can be
processed immediately.
Mailing Address: _________________________
City: ________________________ State: _____ All Water Heaters, Demand Controllers, Heat
Zip: _________ Phone: ( ) _____-________ Pumps, and Geothermal systems are subject to
E-mail: _________________________________ inspection by a BHP Service Technician prior to
rebate approval. Rebate applications must be
Type of Building: submitted within 12 months from date of purchase.
___ Residential ___ Existing ___ Multi-Unit
___ New Construction ___ Commercial
___ Primary Electric Heat Trade Ally Incentive (Paid to Sales Person)
___ Total Electric (Rate 12) To be completed by Trade Ally Contractor only.
___ Demand Service (Rate 14 or 16)
Dealer: __________________________________
Sales Person (req’d): _________________________
Heat Pump & Geothermal Systems:
Address: _________________________________
Make: ___________________________ SEER: _______ City: _______________ State: _____ Zip: ______
Model #: _________________________ Tons: _______
Type:
____ Air to Air Heat Pump - kW of resistance: _________ Electric Water Heater Rebate
____ Geothermal - kW of resistance: _________ Make: ___________________________________
____ Water Source HP kW of resistance: ____________ Model #: ____________________ Gallons: _____
(Commercial Use)
Total Rebate: $___________ ____ Demand Controller Bonus $100
(When purchased at same time as demand controller)
Work Order # _____/65/11406/15 (air to air heat pump)
Work Order # _____/65/10085/15 (geothermal) Total Rebate: $___________
Work Order # _____/65/11406/15 (water heat pump)
Work Order # _____/65/10071/15

Demand Controller Installation:

Electric Resistance Heat Rebate
____ Free standard installation in existing home by (Demand Controller Required)
certified licensed contractor .
____ $200 Rebate - Certified Licensed Installer in new Make: _____________________ Total kW: _____
construction home. Type: ____ Cove _____ Baseboard
____ Ceiling Radiant _____ Furnace
Installed by (Individual’s name)______________________
Total Rebate: $_________
Date: _________
WO# for Free Installation: _____/65/10075/06 Work Order # _____/65/11838/15 (cove only)
WO# for Cash Rebate or Credit: _____/65/10075/15 Work Order # _____/65/10080/15 (all other)

Office Use Only:

Rebate Total: ________________
Sales Person: ________________________________ Date: ________
Heat Pump Inspection: _________________________ Date: ________ _____ Apply to MAR (attach form)
District Manager Approval: ______________________ Date: ________ _____ Apply to Electric Account
(attach form)
Energy Services Approval: _______________________ Date: ________ _____ Issue check to customer

Rev. 1/2008

White - Accounting Department Yellow - Energy Services