Energy Star Electric Heat Pump Water Heaters / Solar Water Heaters
used in combination with an Electric Tank Water Heater Incentive
This offer is for a limited time only, subject to availability of funding.
Please attach the original receipts, along with the energy guide or the booklet that shows the Electric Heat Pump
Water Heater is ENERGY STAR compliant. PUD reserves the right to inspect the installation on premises. Incentive
will be applied to your electric account.
Customer’s Name:
Pascoag Utility District Account Number:
Service Address:
Home/Cell Telephone #:
Type of System (circle one): Electric Heat Pump Water Heater
Solar Water Heater
Manufacturer and Model #:
Please attach the following:
 Original dated receipt or contractors invoice.
 Manufacturer’s specifications and efficiencies.
 A signed Mechanical Permit from the Town of Burrillville.
 Rebates of 5% of the cost, not to exceed $100.
For Pascoag Utility District use only
DSM Rebate Year______________________
Amount of Rebate: _______________________
Reviewer: ___________________________________ Date: ________________
Management approval: ______________________________