Electric Tankless Water Heater Replacement Rebate Application Form

Homeowner's Name:

Purchase Date:

All documentation must be submitted within 60 days of purchase date.

Installation Address:

Cleco Meter # (starts with 168):

Can be found on your bill in the Billing Details section.

City:

City (if not listed in Drop-down)

Zip Code:

Daytime Phone # (no spaces, and include area code):

Parish:

Email Address

Mailing Address (if different from install address)

Mailing Address:

Mailing City:

Mailing Zip Code:

Mailing State:

Tankless Water Heater Details

Brand

Model #

Size of Tank being replaced by tankless unit

Energy Factor

Draw Pattern (choose one)

Very Small
Low
Medium
High

Installation Location

Inside (conditioned space)
Unconditioned space

Space Heating System Type for Home

Tankless Water Heater Rebate Requirements

To qualify for the electric tankless rebate, the unit must be replacing a tanked water heater and must exceed the uniform energy factor listed in the following table: tankless energy factor table

Required Documentation

Proof of Purchase

Photo of Installed Unit

Signature

By submitting below, the purchase certifies that the water heater for which you are claiming a rebate is installed at the address listed above and authorizes Cleco to perform a phone survey or physical inspection to confirm installation. All rebate forms must be received within 60 days of purchase date of your new electric tankless water heater.

Program funding is limited and participation is on a first-come, first-served basis. Offerings are subject to change without notice.

Please allow 4-6 weeks for processing. For more information about this and other energy efficiency programs, visit www.cleco.com/powerwise or call 1-833-373-6842.

Signature

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