Home » Air Source Heat Pump Rebate Application Form
Customer Information
12-digit WMGLD Account Number (required)
Account Holder Name (required)
Email (required)
Phone (required)
Service Address Information
Street Address (required)
Unit #
City/town (required)
State (required)
Zip
Contractor Information
Company Name (required)
Company Email Address
Technician's Name (required)
New Equipment Installed
Appliance (required) —Please choose an option—Ducted Heat PumpDuctless Mini-Split Heat Pump
Brand (required)
Model (required)
AHRI Number (required)
Associated Indoor Unity Model Number(s)
Purchase Date (required)
Please use the chart below to determine the amount of your rebate:
* Actual tons are calculated based on AHRI cooling capacity divided by 12,000 BTUs. Rebate amount based on actual tons.
New Unit Size (tons***)
Rebate Amount
By clicking the "Submit Application" button, you certify that all information in this form is correct, to the best of your knowledge, and that you adhere to all terms and conditions of this rebate.
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