Optional Seasonal Heat Pump Rate Questionnaire

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Optional Seasonal Heat Pump Rate Questionnaire

Customer Information

heat sole Heat

12-digit WMGLD Account Number:

Account Holder Name

First

Last

Phone

Utility Account/Installation Address (please do not list P.O. Box #)

Address

Address Line 1

Address Line 2

City

State

Zip Code

Do you use your heat pumps/mini splits for heating?

What year were heat pumps installed?

Heat Pump Unit Size (tons)

Are heat pumps your sole heating source?

Do you have fossil fuel at your residence? (Gas, Oil, etc.)

Verification

By Checking this box I verify that I would like to sign up for the Seasonal Heat Pump Rate and understand that if I am a gas heat customer, my rate will be changed to the gas non-heat rate (increasing the per CCF cost by $0.20).

Attachment #1

Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.

Attachment #2

Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.

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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Thursday 7:30 – 6:00

Friday 7:30 – 1:00

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