If different from above, name, address and city where new heating system is installed

CenterPoint Energy acct# where new heating system is installed

Purchaser's Email address (for questions on rebate paperwork)

City / State / ZipMailing address

Home phoneDaytime phonePurchaser's name

X Purchaser's signature Date

Type of buildingTownhomeSingle-family Two-plex to four-plex

Purchaser type Owner BuilderLandlordRenter Agency

Replacement (includes additions / remodel)New home construction

Type of installation

PURCHASER INFORMATION (CenterPoint Energy Minnesota natural gas customers - please print.)

Dealer ID*

Email address

City / State / ZipAddress

Company Name Dealer phone

X Dealer or installer signature Date

DEALER INFORMATION (To be completed by heating dealer - please print.)

It is the responsibility of the dealer and the purchaser to ensure that the program requirements are met. If program requirements are not met, no rebate will be paid. *CenterPoint Energy assigns six-digit Dealer ID numbers to participating dealers. If ID number is not assigned, rebate can still be submitted and dealer should contact us to acquire one.

Return completed form with required signatures and a detailed copy of the dated sales invoice from heating dealer to: CenterPoint Energy Heating System Rebate P.O. Box 59038 Minneapolis, MN 55459-0038

Heating system (select one) Forced air furnace Natural gas boiler

AFUE %Serial # 2016 Date of installation

BTU/hr inputComplete model #Brand

EQUIPMENT INFORMATION (To be completed by heating dealer - please print.) See reverse side for rebate amounts.

Program dates: Jan. 1, 2016 through Dec. 31, 2016

Please complete one form per heating system purchased and installed. Rebates must be submitted in the calendar year of installation. To receive your rebate, please submit all requested information, including a detailed copy of the dated sales invoice from your heating dealer and all requested signatures. Please see other side for program guidelines.

COMPLETION OF ALL FIELDS IS REQUIRED FOR PAYMENT

RESIDENTIAL HEATING SYSTEM REBATE MINNESOTA

CNP 1153 (1-2016)

Rebate contact name

RESIDENTIAL HIGH EFFICIENCY HEATING SYSTEM REBATE GUIDELINES The qualifying equipment must be installed in a Minnesota home served with natural gas from CenterPoint Energy between January 1 and December 31, 2016. All completed applications must be post marked by December 31, 2016 to be considered for a rebate.

Heating dealers are not eligible to receive their customer's rebate. Building contractors should negotiate with homeowners to determine who receives the rebate. Equipment installed under warranty replacement does not qualify for the rebate. CenterPoint Energy reserves the right to inspect the installed equipment.

NOTE: For rebate to apply the new equipment must be listed and AFUE verified on the current Air Conditioning, Heating and Refrigeration Institute or ENERGY STAR® website. See AHRIdirectory.org or energystar.gov APPLICATION CenterPoint Energy cannot process a rebate without all the requested information on the rebate form and invoice. Work with your heating dealer to complete the entire rebate application and obtain a dated sales invoice showing the detail of what was purchased and installed.

The purchaser of the heating system and a representative from your retail heating dealer are required to sign the rebate application.

ATTACH PROOF OF PURCHASE AND INSTALLATION Required information on dated sales invoice includes: Purchaser name, installation address, brand, complete model number and serial number of heating system and the dealer company name and address.

HELP WITH FORMS If you have questions filling out this form, please contact your heating dealer for assistance.

If your are building a home, you must obtain an invoice from your builder or heating dealer. Only one rebate per piece of equipment.

PROCESSING Completed rebate forms will be processed in the order in which they are received and are paid on a first-come, first served basis. Account number must be activated for installation address in order for rebate to be processed. CenterPoint Energy is not responsible if the dealer does not provide accurate information about the amount of a rebate or equipment eligibility. Rebate qualifications and amounts are subject to change. CenterPoint Energy Conservation Improvement Program (CIP) rebate programs may be cancelled or changed at any time. CenterPoint Energy issues a cash rebate not utility bill credits. Please allow 8 weeks to receive payment in the mail from the time that CenterPoint Energy receives your completed paperwork. If you haven't received payment after this time, call 612-399-1545 or email RebateCenter@CenterPointEnergy.com

APPLICATION CHECKLIST SEND COMPLETED APPLICATION TO: □ All fields on form completed Heating System Rebate □ Purchaser signature CenterPoint Energy □ Dealer signature PO Box 59038 □ Dated itemized sales invoice from heating dealer Minneapolis, MN 55459-0038

$350 Forced-air furnace (new construction) 95% or higher

$300 Natural gas boiler

Natural gas boiler$500

83.5-90.9%

91% or higher

$400 Forced-air furnace (replacement)

$300 Forced-air furnace (replacement)

Heating Rebate

$150

96% or higher

94-95.9%

$50 Forced-air furnace (new construction) 92-94.9%

Type of natural gas heating system AFUE rating on current AHRI or ENERGY STAR website

Forced-air furnace (replacement) 92-93.9%

2012 REBATE OFFERING

REBATE GUIDELINES

Plumbers and dealers are not eligible to receive their customer's rebate. Building contractors should negotiate with homeowners to determine who receives the rebate. Equipment installed under warranty replacement does not qualify for the rebate.

Rebate applies to new equipment listed and AFUE verified in the Air Conditioning, Heating and Refrigeration Institute (AHRI) directory.

APPLICATION CHECKLIST SEND COMPLETED APPLICATIONS TO:

Completed rebate forms will be processed in the order in which they are received and are paid on a first-come, first served basis.

All requested paperwork needs to be submitted by December 31 in the calendar year of installation. Program closes December 31, 2012 and all completed forms must be post-marked by December 31 in order to be considered for a rebate.

$200Indirect storage tank installed with 91% or greater condensing boiler.

Potable volume 19-75 gallons 2° or less

.67 EF ENERGY STAR qualified

.63-.66 EF

.62-.63 EF (Energy factor)

REBATE APPLICATION AND INVOICEWork with your dealer or plumber to complete the entire rebate application and obtain a dated sales invoice showing the detail of what was purchased and installed.

Required information on dated sales invoice includes: Brand, complete model number and serial number of water heater and the dealer company name and address.

The purchaser of the water heater and a representative from your retail dealer or plumber or installer are required to sign the rebate application.

Rebate will be issued for equipment installed between Jan 1, 2012 and Dec. 31, 2012.REBATE PROCESSING

$100 Storage tank

$85 Storage tank

Rebate amount Type of natural gas water heater

$70 Storage tank

PROOF