AC Rebate

Note: This rebate request can only be submitted by the contractor completing installation of the equipment.
Are you a contractor*

YesNo (if no is selected rebate application cannot proceed)
Are you on our list of qualified installers*

YesNo (if no is selected rebate application cannot proceed)
Find a qualified installer.
Member information
Name on account*

First NameLast Name
Connexus account number
Phone number
Email address
Installation address*

Street Address

Street Address Line 2

CityState

Zip Code
Contractor information
Company*
HVACREDU/NATE ID*
Primary rebate contact name

First NameLast Name
Installation technician name

First NameLast Name
Company address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone number
Please enter a valid phone number.
Primary rebate contact email address
example@example.com
Equipment information
SEER2 rating*
EER2 rating*
HSPF2 rating
Tons*
Compressor type

Single speedVariable speed
AHRI certificate number*
Date of installation*

MonthDayYear
Date
Manufacturer*
Model number*
Serial number*
Condenser model number*
Condenser serial number*
Evaporator coil model number*
Evaporator coil serial number*
Previous AC equipment information
SEER rating*
EER rating*
Attach all itemized invoices/receipts, specification sheets and AHRI Certificate associated with the purchase/installation of the project.

Cancelof
Member hereby certifies that 1) the member is solely responsible for the accuracy of the application information; 2) all installation is complete and operational prior to submitting this application; 3) acknowledges that nothing contained in the application shall impose any liability on Connexus Energy for any work performed or information presented by the member’s engineer, contractor, or vendor; and 4) Connexus reserves the right to verify performed work.
Signature*

Clear
Please verify that you are human*
Should be Empty:

Member information

Contractor information

Equipment information

Previous AC equipment information