AC Rebate

Note: This rebate request can only be submitted by the contractor completing installation of the equipment.
YesNo (if no is selected rebate application cannot proceed)
YesNo (if no is selected rebate application cannot proceed)
Member information
Name on account*

First NameLast Name
Connexus account number
Phone number
Format: 000-000-0000.
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.Format: (000) 000-0000.
Primary rebate contact email address
example@example.com
Equipment information
SEER2 rating*
EER2 rating*
Tons*
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