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RESIDENTIAL HVAC SYSTEM TUNEUP - IOWA
2017 REBATE CLAIM FORM
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INSTRUCTIONS: Fill out form completely and sign. Attach supporting documentation: receipt(s) of service. Failure to complete the form and
provide documentation could result in claim being sent back or denied.
Alliant Energy is the trade name of Interstate Power and Light Company (IPL). The utility providing the rebates is Interstate Power and Light
Company (IPL), an Alliant Energy company, hereinafter referred to as Alliant Energy.
Questions about the forms or need assistance with the forms? Call our Energy Efficiency Hotline at 1-866-ALLIANT (1-866-255-4268).
CUSTOMER INFORMATION
Rebate Applicant Information
Building Information
Person or Company Receiving Rebate
Installation Address
Applicant Email Address
City
Mailing Address
Alliant Energy Account No. at Installation Address
City
State
Zip
Iowa
State
Zip
Year House Built (required)
Phone No.
Primary Contact Person for Claims Questions
(
)
Residential Building Type
 Single-Family/Duplex
 Manufactured Home
 Apt./Condo (3+ Units)
Applicant Tax Status
 Residential
 Sole-Proprietor*
 Partnership*
 Government
 Non-Profit
 Corporation
 Religious
*If sole-proprietor or partnership, the applicant must provide a copy of a W-9 showing the Social Security Number or Employer Identification Number and the legal
name associated with the number provided on the document. To comply with IRS regulations, the applicant must provide a copy of a W-9 each time a claim is
submitted.
HVAC SYSTEM TUNEUP
Professionally conducted clean and tune up on a central air conditioner, air-source heat pump, geothermal, natural gas furnace or boiler system. Maximum one
tuneup per year per heating or cooling system. Alliant Energy must supply the energy to the equipment being serviced. For existing homes built before 2012.
Customer must include copy of receipt with this form.
HVAC equipment BTUH (required - information should be obtained from HVAC contractor)
Date Tuneup Performed
 Air Conditioner
____________BTUH
 Geothermal
____________ Heat BTUH
____________ Cool BTUH
 Boiler
 Natural Gas Furnace
____________BTUH
 Air-Source Heat Pump____________ Heat BTUH
____________ Cool BTUH
____________BTUH
Service Cost
Rebate (50% of service cost minus manufacturer or dealer rebate or coupons. Not to exceed $50.)
$
$
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SPECIFIC TERMS AND CONDITIONS
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A. Alliant Energy must supply the energy to the equipment being serviced.
B. Maximum of one tuneup rebate per year, per qualifying heating or cooling system.
C. Rebate not to exceed 50 percent of service cost, up to $50.
D. HVAC equipment BTUH required for rebate payment.
GENERAL TERMS AND CONDITIONS
IMPORTANT: Before completing and signing the form, please read the General Terms and Conditions located in the rebate booklet, or at alliantenergy.com/forms.
• No Endorsement. Alliant Energy may have Dealer Participation Agreements with Dealers listed on the reverse of this document. However, Alliant Energy, its affiliates, employees,
or agents (“Alliant Energy Parties”) do not endorse any manufacturer, product, system design, claim, or vendor in connection with this rebate program.
• Limitation on Liability. Alliant Energy Parties’ liability will not exceed the amount of the rebate. Alliant Energy Parties are not liable for any equipment or services provided in
connection with this rebate program. In no event will Alliant Energy Parties be liable for any special, incidental or consequential damages.
• Indemnification. Customer and Dealer agree to defend, indemnify, and hold harmless Alliant Energy Parties from and against any and all loss, damage, expense, fees, costs and
liability of any kind (including attorney’s fees and court costs) arising from any claims related to the equipment, services, Dealer Participation Agreement, or this rebate claim.
• No Warranties. Alliant Energy makes no warranties or representations of any kind regarding the equipment or any service provided in connection with this rebate program.
• Customer Certification. Customer certifies that it purchased and will install the equipment listed on this rebate claim and that the information provided is true.
CUSTOMER SIGNATURE AND CERTIFICATION
I agree to the terms and conditions associated with this form.
 Dealer serviced equipment (Dealer/Contractor must fill out Dealer Contractor or Store box below)
Customer Signature
Date
FOR DEALER, CONTRACTOR OR STORE ONLY (REQUIRED)
Dealer/Contractor/Store Name
Dealer ID (if applicable)
Phone No.
(
Address
)
State
City
ZIP
I certify that the service information provided on this application is correct and accurate.
Dealer/Contractor Signature:
Date:
Mail completed forms to:
Before you turn in your form:
 Fill out the form completely.
 Attach a copy of the sales receipt or invoice. Circle the energy-efficient
equipment on the receipt.
 Include documentation listed in the instructions.
 Sign the Customer Signature and Certification section. If a dealer installed the
equipment, the dealer must sign the Dealer, Contractor or Store section.
 Please submit your completed rebate form promptly along with any
required receipts/invoices. The sooner we receive your claim form, the
sooner you get your rebate! Rebate claims must be received no later
than January 31, 2018 to be eligible.
Alliant Energy Rebate Center
P.O. Box 938
Cedar Rapids, IA 52406-0938
FAX: (319) 450-0218
To avoid delays and processing errors,
please choose only one option. Do not fax
AND mail your form.
This program is administered by Alliant Energy. Rebate processing services are fulfilled for Alliant Energy by Michaels Energy located in Cedar
Rapids, Iowa.
Please allow up to six to eight weeks for your rebate on a prepaid Visa® card, after Alliant Energy receives your properly completed rebate
claim form, receipts and any other required materials. Cards are issued by Citibank, N.A. pursuant to a license from Visa U.S.A. Inc. and
managed by Citi Prepaid Services. Cards will not have cash access and can be used everywhere Visa debit cards are accepted.
Questions? Call 1-866-ALLIANT (1-866-255-4268) or visit us online at alliantenergy.com/rebates.
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