Ductless Mini-Split Heat Pump Rebate - Xcel Energy

1 Page 1 of 2 21-01-503 | CRS 5073 MinnesotaApplicationMini- split heat Pump RebateRead all Rebate qualifications on the back page of this form. Application will be returned without valid purchase holder informationXcel Energy account number where unit was installed _____ Phone _____ Account holder name _____ Email _____ As shown on your utility billInstallation address _____ City _____ State _____ ZIP _____Mailing address _____ City _____ State _____ ZIP _____ If different from installation addressAccount holder hereby certifies that 1. the account holder is solely responsible for the accuracy of the application information; 2. all installation is complete and operational prior to submitting this application; 3. all rules of this xcel Energy program (listed on back) have been followed; 4. xcel Energy is not liable for any work holder signature _____ Date _____Alternate Rebate recipient: Complete this section only if the Rebate should be issued to someone other than the account holder named _____ Daytime phone _____Address _____ City _____ State _____ ZIP _____I authorize the above party to receive the Rebate holder signature _____ Date _____Equipment informationInstallation date _____Manufacturer _____ HSPF _____ Heating BTUH _____AHRI reference number _____ SEER _____ EER _____ Cooling BTUH _____Outdoor unit model number _____ Outdoor unit serial number _____Indoor unit model number _____ Indoor unit serial number _____(For one-to-one split systems only) Ductless Mini-Split heat pump will be used for: Cooling and heating Cooling only Heating onlyLocation of indoor unit(s)/air handler(s).

2 Bedroom(s) New addition Living rooms Kitchen Office Other _____Number of indoor units _____ Home type: New construction Existing homeContractor informationContractor company name _____Primary Rebate contact person _____ Phone _____Address _____ City _____ State _____ ZIP _____Xcel Energy contractor ID# _____ Email _____I hereby certify that all information is accurate, including claims of efficiency, size and account holder informationContractor signature _____ Date _____For Rebate Operations use only. Do not write in this sent by: _____ Rebate amount: _____Completed by: _____ Date purchased: _____ Date installed: | 2021 xcel Energy Inc. | xcel Energy is a registered trademark of xcel Energy Inc. | 21-01-503 | CRS 5073 Ductless Mini-Split heat Pump RebateApplicationMinnesotaRebate detailsXcel Energy issues cash rebates in the form of checks, not utility bill credits.

3 xcel Energy is not responsible if your contractor provided inaccurate information about the amount and/or conditions of the actual Rebate or equipment detailsAccount holder applications must be postmarked no later than September 30 of the year following purchase date of qualifying phone calls will be accepted to provide equipment application that is denied due to equipment ineligibility will not be accepted with changed model copy of the dated sales receipt or invoice must accompany complete information on the front of this form. The product invoice must specify all required information. Failure to complete this information will result in a returned Energy reserves the right to refuse payment and participation if the account holder or contractor violates program rules and procedures. xcel Energy is not liable for rebates promised to account holder as a result of a contractor misrepresenting the program.

4 xcel Energy does not expressly or implicitly warrant the performance of installed equipment (contact your contractor for detailed equipment warranties).All information on the receipt or invoice must match the information on the Rebate application or the application will not be reserve the right to conduct random inspections to verify installation of the rebated equipment at the address indicated on the front of this form. Your assistance is qualifications and amounts are subject to change anytime. Our Rebate programs may be cancelled with 30 days visit us at or call 800-895-4999 to determine whether any program changes have promotionsDuring special promotions for this program, it is the account holder/contractor s responsibility to ensure all paperwork is postmarked by the deadline. xcel Energy will not pay special promotion incentive dollars in the event that a form is lost or not postmarked by the deadline.

5 No exceptions. Promotional Rebate amounts will be automatically calculated by xcel Energy . Promotion deadlines close at midnight on the date the application is due, with no with formsIf you are building a new home, you must obtain a sales receipt for the equipment from your builder. Only one Rebate per piece of equipment will be you have questions while filling out this form, please contact your contractor for assistance. Please allow at least six to eight weeks for your Rebate to account holdersXcel Energy electric residential account holders in Minnesota are eligible for rebates when buying qualifying, high-efficiency, new Mini-Split heat pumps . Reconditioned equipment is not understand they are not eligible to receive a Rebate for this improvement earned under a different xcel Energy Rebate ratingRebateMini- split heat pump with gas furnace (15+ SEER, 11+ EER; 9+ HSPF)$300 Mini-Split heat pump with electric resistance heat (15+ SEER, 11+ EER; 9+ HSPF)$600 Qualifying equipmentMini- split heat pumps must be rated with a minimum efficiency level of 15 SEER, 11 EER and 9 residential equipment listed on the AHRI directory ( ) will qualify.

6 Efficiency ratings are determined using the Air-Conditioning, Heating, and Refrigeration Institute (AHRI) directory, Submitting an AHRI certificate with your application and invoice is highly include the items listed below on your application form and purchase receipt/invoice. If all of the items are not included the Rebate cannot be to xcel Energy (and keep a copy): 1. Your purchase receipt/invoice, with these details: Account holder name Installation address Manufacturer Purchase date Condenser model and serial number Cooling/Heating BTUH or tons Invoice date SEER, EER, and HSPF efficiency ratingsTotal Purchase Amount _____Contractors keep in their file: 1. A copy of everything sent to xcel EnergySend complete application materials to: xcel Energy Rebate Box 829 Minneapolis, MN 55440-0829orEmail (for submission only): online: customer?Call the Business Line at 800-481-4700