Electric Heat Pump Water Heater Incentive

Note: Incentive must be redeemed within 6 months of purchase date. You must be a member of Midstate Electric Cooperative. Your purchase receipt must accompany this incentive form and list your qualified water heater model number.

URL

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

Send Incentive Check To:

Name(Required)

First Last

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone Number(Required)

Email(Required)

Water Heater Installed At:

Name

First Last

Location of Install(Required)

Same as previous

Street Address Address Line 2 City State ZIP Code

Phone Number(Required)

Water Heater Information

Brand Name

Purchased At

Model Number

Warranty (Years)

Purchase Receipt(Required)

Your purchase receipt must accompany this form. Must list your qualified water heater model number.

Max. file size: 50 MB.

Member Signature (Full Name)(Required)

This form is also available to download, print, and return: Electric Heat Pump Water Heater Incentive (PDF)