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Air to Air HVAC Rebate Application

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Home // Energy Efficiency // Rebates // Air to Air HVAC Rebate Application

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Complete the form below, or print and return: Air Source Heat Pump Application (PDF)

Comments

This field is for validation purposes and should be left unchanged.

Member Name(Required)

First Last

Account #

Phone(Required)

Email(Required)

Address(Required)

Physical address where insulation was installed

Street Address Address Line 2 City State ZIP Code

Is this a new home installation?(Required)

Yes

No

Old/Existing Equipment Info

Reason for replacing existing heating and air-conditioning equipment:

Retrofit (old unit/equipment still works, etc.)

Replacement (equipment has failed)

Please provide reason for replacing the existing unit:

What type of heating system did the home previously have?

Gas-Forced Air

Electric Resistance-Forced Air

Ground Source Heat Pump

Duel Fuel Heat Pump

Electric Heat Pump

Wood

Other

EER

SEER

HSPF

Year Date

(If SEER or EER are not available; please provide date of installation of existing unit)

What type of cooling system did the home previously have?

Central Air Conditioning

Window Units

Ground Source Heat Pump

Duel Fuel Heat Pump

Other

SEER

EER

BTU/Tons

How many?

Year Date

(If SEER or EER are not available; please provide date of installation of existing unit)

New Heat Pump Equipment Info

Serial #

Model

Capacity in BTU/Tons

SEER Rating (Minimum of 16)

EER Rating (Minimum of 13.4)

HSPF Rating (Minimum of 8.5)

Total Cost of Installation ($)

Installation Date of the Heat Pump(s) (MM/DD/YYYY)

Month

Day

Year

What type of system was installed?

Package

Split

Ductless Mini Split

Other

What type of back-up/supplemental) heating system will the new heat pump use?

Propane

Natural Gas

Electric

Other

Electric kW

Attached the following required material:

Copy of check or credit to consumer, AHRI Reference sheet(s), Copy of invoice from contractor, Copy of Manual J

Drop files here or

Max. file size: 100 MB.

Summary & Signatures

Retailer/Contractor Information:

HVAC Contractor Name

Contact Person

Phone

Contractor Address

Street Address Address Line 2 City State ZIP Code

Member Signature:

Member's Consent(Required)

I certify that the information within this application is correct, including claims of efficiency, size, and HVA system information. I recognize that Kay Electric may contact me to verify the information that I have provided.

Member Signature (Full Name)(Required)

Supplementary Information

Please attach and submit all pertinent supplementary information with this application including receipts, technical specifications, etc.

Drop files here or

Max. file size: 100 MB.

Keep In Touch

Main Office

300 West Doolin Avenue
Blackwell, OK 74631

Directions to Main Office

Mailing Address

PO Box 607
Blackwell, OK 74631

Office Hours

Monday through Friday
8 a.m. to 5 p.m.

Contact Us

Main Office: (580) 363-1260

Toll-Free: (800) 535-1079

Fax: (580) 363-2308

Email: contact@kayelectric.coop

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