ENERGY STAR-certified Heat Pump Water Heater Replacement 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:

Heat Pump Water Heater Details

Brand

Model #

Tank Size of HPWH:

Energy Factor:

First Hour Rating (gallons)

Installation Location

Inside (conditioned space)
Unconditioned Space

Space Heating System Type of Home

Heat Pump Water Heater Rebate Requirements

In order to qualify for the HPWH rebate, the model # must be listed on the ENERGY STAR website:

https://www.energystar.gov/productfinder/product/certified-water-heaters/

Required Documentation

Proof of Purchase

Photo of Installed Unit

Signature

By submitting below, the purchase certifies that the water heater for which they 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 date purchased of your new 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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