Rebate Application - Weatherization

All account information will be kept confidential between the Cooperative, Associated Electric Cooperative and agents acting on their behalf.

Name: *

Co-op Account Number: *

Phone Number *

Area Code Phone Number

Email address: *

example@example.com

Install date: *

Date

Address (where unit is installed) *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Is the mailing address different than the installed address? *

Yes No

Mailing address (if different than installed address) *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Primary or vacation home? *

Primary Home Vacation Home

New or existing home? *

New home Existing home

Is this a rental property? *

Yes No

Did the rebate influence your purchase decision? *

Yes No

How many people live in the home? *

The Cooperative will refund 50%, up to $500, of the cost of the repairs/improvements by the auditors report. Please list each repair made and the amount paid. This form is for weatherization repairs/improvements only and members must have a current energy audit completed through their cooperative.

Energy Efficiency Measures Installed Based on the Audit #1 *

Cost #1 *

Energy Efficiency Measures #2

Cost #2

Energy Efficiency Measures #3

Cost #3

Energy Efficiency Measures #4

Cost #4

Total Dollars Spent (Add Costs 1-4) *

Total Rebate Amount (Half of Total Dollars Spent, Up to $500) *

Attach a copy of the receipts: *

Browse Files

FILE TYPES ACCEPTED: PDF, ZIP, JPG, PNG

INSTRUCTIONS

Please allow 30 days for processing. Keep a copy of this document for your records.
You must include a copy of the original dates dales receipt with this application
Include your account number and sign the form
Incomplete applications will not be processed for rebates
Submit completed application and sales receipt to your local electric cooperative within 90 days of purchase
Additional terms and conditions apply. See the back of this form for details.

ELIGIBILITY CRITERIA

Must be a member in good standing with the cooperative
Audits are available for new or existing homes
On new homes, it is recommended that the audit take place after the home is sealed and before sheet rock and insulation have been installed.
A separate audit form must be completed for each installation site
Must comply with the Home Audit Measure Procedures outlined below
Multiple occupancy (apartments, duplexes, dormitories) buildings are eligible for a weatherization rebate on a single structure basis, (not a single unit basis). One cost-shared audit on a single unit can be paid to the co-op to determine base-line energy use. The building owner is eligible for the weatherization rebate (up to $500).

REBATE REQUIREMENTS

Member/auditor must fill in all information requested on the AECI Residential Energy Audit 5-page form located at the Take Control & Save area of AECI’s Member’s web site.
Member/auditor must submit the form to local cooperative
Cooperative must verify account number, name and address of member
Rebate program is limited to cooperative services that purchase 6,000 or more kilowatt-hours from the cooperative on an annual basis. Eligible services include lake homes, workshops, and barns, etc.
The rebate amount is limited to 50 percent (50%) of the total cost of the unit.

DISCLAIMER

The cooperative is not responsible if your contractor, retailer, builder or other party provides you with inaccurate information about the amount or conditions of the actual rebate. The cooperative will not rebate equipment that has been mislabeled, misrepresented or previously owned. The cooperative reserves the right to inspect the equipment and its installation at the address indicated on the front of this application. The cooperative is not responsible for any lost, late, stolen, ineligible, misdirected or postage due mail. All completed applications will become the property of the cooperative. Rebate qualifications and amounts are subject to change at the cooperative’s discretion and the program may end at any time without notice.

Do you accept the terms, conditions and qualifications above? *

Yes No

Please accept before proceeding.

MEMBER SIGNATURE (Certifies that the appliance(s)/unit(s) listed meet program requirements and that they are installed at the address listed. I agree that the cooperative may verify installation at the address listed.) *

E-Signature must exactly match name as it appears above.

HOME ENERGY AUDIT WEATHERIZATION REBATE

MEMBER INFORMATION

RESIDENTIAL INFORMATION

REBATE QUALIFICATIONS