Purchaser signature DateIt 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.

Return completed form with required signature and a clear copy of the detailed retailer receipt/invoice to: CenterPoint Energy Water Heater Rebate P.O. Box 59038 Minneapolis, MN 55459-0038

Installer phone*Installer name (if different from purchaser name)

Store location, city and state

RETAILER AND INSTALLER INFORMATION (Complete the entire section - please print)

Retailer name

2020 Date of installation Serial number

Complete model #Brand

Water Heater Type (select one) Tankless [078] Tank <75,000 BTU/hr [013] Commercial Tank >75,000 BTU/hr [071]

EQUIPMENT INFORMATION (Complete the entire section - please print)

Purchaser Email address Alt phonePhone

RenterBuilder AgencyLandlordOwnerPurchaser Type (select one)

Rebate check mailing address, city, state and ZIP (if different from installation address)

Rebate check payable to:

Type of Retailer (select one)

Store

Online

PURCHASER INFORMATION (Equipment purchaser and rebate check recipient - please print)

Replacement (existing home or business) New ConstructionType of Installation (select one)

OtherSit-down Restaurant Warehouse Women Dormitories

Nursing HomeMen Dormitories Motel Office Building Retail Store

Hospitals Laundromat

Fitness Center

Correctional Facility

Grocery Store Health Clinic Jr. High/High School Hotel

Comm. Laundry FacilitySingle-family home Fast Food RestaurantTownhome Multi-family Elem. School

Type of Building (select one)

INSTALLATION INFORMATION (CenterPoint Energy service and equipment installation address - please print)

Installation address, city, state and ZIP

CenterPoint Energy Gas Account Number for the address where the new water heater was installed

WATER HEATER REBATE RETAIL ARKANSAS

This rebate form is for new qualifying High Efficiency Gas Water Heaters purchased from a retailer. Program dates: Jan. 1, 2020 through Dec. 31, 2020 1) Review the Terms & Conditions on the back of this form to ensure all program requirements are met. 2) The new equipment must be listed in the current AHRI (Air Conditioning, Heating and Refrigeration Institute) or ENERGY STAR® website. See website: ahridirectory.org or energystar.gov/products. 3) Complete the entire application, including signature. 4) Attach a clear copy of the retailer receipt/dated invoice. 5) Application must be submitted in the same calendar year that the equipment was installed.

White - CenterPoint Energy Yellow - Customer/Purchaser CNP 1117B (1-2020)

*If the water heater was installed by a plumber or dealer then include a copy of the installation invoice. See back of form for invoice requirements.

WATER HEATER REBATE TERMS & CONDITIONS The qualifying equipment must be installed in a home or business served with natural gas from CenterPoint Energy in Arkansas or Texas communities of Texarkana, Nash, Redwater or Wake Village between January 1 and December 31, 2020. All completed applications must be postmarked by December 31, 2020 to be considered for a 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 only. One application must be completed for each qualifying water heater installation.

*Replacing an electric water heater for a natural gas model is not eligible for a rebate. For a list of examples of eligible tank water heaters, go online to CenterPointEnergy.com/WaterHeaterRebate.

NEW CONSTRUCTION INSTALLATIONS For New Construction installations, the building contractor should negotiate with homeowners to determine who receives the rebate. If you are building a new home, you must obtain an invoice from your builder or the retailer/plumber.

CENTERPOINT ENERGY GAS ACCOUNT NUMBER Customers can obtain their gas account number from their monthly bill statement, or online at CenterPointEnergy.com/MyAccount.

PROOF OF PURCHASE AND INSTALLATION A clear copy of the dated sales invoice/retailer receipt must be included with the completed rebate application. The receipt must describe the water heater that was purchased. It cannot be a packing list, recall or generic receipt.

Plumber/Installer Invoice If a plumber installed the water heater that was purchased from a retailer, then include a copy of the installation invoice from the plumber with the rebate application. The invoice must include the customer name, installation address, purchase date, itemized listing the brand, complete model and serial number and any other identifying information. CenterPoint Energy is unable to accept applications that do not include all the requested information.

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. Only one rebate per piece of equipment will be paid. Account number must be activated for installation address in order for rebate to be processed. CenterPoint Energy is not responsible if the retailer 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 8 weeks, please call 612-399-1545 or email RebateCenter@CenterPointEnergy.com. Rebate checks are issued from our Houston, TX office and expire in 90 days from the date that the check was issued.

APPLICATION CHECKLIST SEND COMPLETED APPLICATION TO: □ All fields on form are completed Water Heater Rebate □ Purchaser signature CenterPoint Energy □ Dated receipt/sales invoice from PO Box 59038 retailer/installer (if plumber installed) Minneapolis, MN 55459-0038

REBATE

Commercial Tank (>75,000 Btu/hr)

Tank - less than 75,000 BTU/hr 0.70 UEF or greater

88% Thermal Efficiency or higher

0.80 UEF or higher

$200 per 100,000 BTU, not to exceed 25% of total equipment cost

$75

$500 Additional $1000

N/A

N/A

Type of Natural Gas Water Heater

Uniform Energy Factor (UEF) according to AHRI Water Heater Rebate

Combination Rebate If qualifying 95% AFUE furnace is installed in the same calendar year

Tankless