If different from above, name, address and city where water new heater is installed

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

Required: CenterPoint Energy acct # where new water heater is installed

City / State / ZipMailing address

Home phoneDaytime phonePurchaser's name

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

Program dates: Jan. 1, 2014 through Dec. 31, 2014 Please complete one form per water heater purchased and installed. Rebates must be submitted in the calendar year of installation. To receive your rebate, please submit all requested information, including a copy of the dated invoice from your retail water heater dealer, and all requested signatures. Please see other side for more information. If you have additional questions you can contact us at 612-399-1565 or 888-525-1565 or send us an email at RebateCenter@CenterPointEnergy.com

Send completed form with dated invoice and required signatures to: CenterPoint Energy Water Heater Rebate, PO Box 59038, Minneapolis, MN 55459-0038.

X Dealer/Plumber or Installer signature Date

Dealer / Plumber Email address

Installer phoneInstaller

City / State / ZipAddress

Company name Dealer/retailer phone

DEALER / PLUMBER OR RETAILER INFORMATION (where purchased)

It is the responsibility of 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 be submitted and dealer should contact us to acquire one. Leave the Dealer ID blank if self-installed.

RenterPurchaser type Owner Landlord

Type of building Single-family home Townhome Two-plex to four-plex

Replacement (includes additions / remodel) New home construction

Agency

Type of installation

Builder

Please read the following and respond to question #3. The Minnesota Department of Commerce requests that CenterPoint Energy track the following information for reporting purposes only. 1. Find your household size on the table to your right. 2. Determine your annual household income, before taxes, including pension, social security, etc. 3. Is your household income above or below the amount corresponding to your household size in this table? Above Below

# of people in household1

2

3

4

5 or more

Annual household income$22,694

$29,677

$36,659

$43,642

$50,625

X Purchaser's signature Date

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

Indirect water heater when installed with new condensing boiler (91% AFUE or higher)

Natural gas water heater (select one) TanklessTank

2014 Date of installation Standby loss (°F/hr)Potable volume (gallons)

Brand Complete model # Serial #

2014 Date of installation

Serial #

Energy Factor

Complete model #

Size or capacity/gallons

Brand

RESIDENTIAL WATER HEATER REBATE MINNESOTA

White - CenterPoint Energy Yellow - Customer Pink - Dealer CNP 1007 (1-2014)

Dealer ID**

RESIDENTIAL HIGH-EFFICIENCY WATER HEATER REBATE 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, 2014.

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. CenterPoint Energy reserves the right to inspect the installed equipment.

Rebate applies to new equipment listed and EF (Energy Factor) verified in the Air Conditioning, Heating and Refrigeration Institute (AHRI) directory. See AHRIdirectory.org.

2014 REBATE OFFERING

REBATE APPLICATION AND INVOICE Work 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.

CenterPoint Energy cannot process a rebate without all the requested information on the rebate form and invoice.

REBATE PROCESSING Rebate will be issued for equipment installed between Jan 1, 2014 and Dec. 31, 2014.

All requested paperwork needs to be submitted by December 31 in the calendar year of installation. Program closes December 31, 2014 and all completed forms must be post-marked by December 31 in order to be considered for a rebate.

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.

APPLICATION CHECKLIST SEND COMPLETED APPLICATION TO: ○ Dated sales invoice Water Heater Rebate ○ Purchaser signature CenterPoint Energy ○ Dealer/Installer signature PO Box 59038 ○ CenterPoint Energy account number Minneapolis, MN 55459-0038

$200Indirect storage tank installed with a new 91% or higher condensing boiler installation.

$100 Tank

$350 Tankless

$250 Tankless

$85 Tank

Mail-in rebate Type of natural gas water heater

$70 Tank

Potable volume 19-75 gallons 2° or less

.67 or greater EF ENERGY STAR qualified

.64-.66 EF

Energy Factor according to AHRI directory-AHRIdirectory.org

.62-.63 EF

.90 or greater EF

.82 - .89 EF