Member Rebate Request Form

To receive your rebate the quickest, please fill out this form and provide all necessary documentation. Failure to provide all of the required information will delay the process.

Rebates relating to insulation & air sealing, please contact lmrememberservices@fesco-oh.org

For information on commercial and industrial rebates, please contact KAED@fesco-oh.org

Questions, comments or concerns about this form, please contact KAED@fesco-oh.org

First

Last

Account Number

Contact Phone Number

Email Address

Address

Address 2

City/Town

State

ZIP code

Geothermal Rebate

Manufacturer

Size (tons)

Energy Efficiency Rating (EER)

Coefficient of Performance (COP)

Type of system replaced

Heating Backup

Water Heating Option

Closed/Open Loop/DGX

Loop Type

Receipt/Proof of Purchase

Choose file

One file only.
20 MB limit.
Allowed types: jpg, png, tif, pdf, doc, docx.

Heat Pump Rebate

System

Size (tons)

SEER/SEER2 Rating

Heating Seasonal Performance Factor (HSPF/HSPF2)

Heating Backup

Type of system replaced

Receipt/Proof of Purchase

Choose file

One file only.
20 MB limit.
Allowed types: jpg, png, tif, pdf, doc, docx.

Electric Water Heater

Manufacturer

Tank size

Type

EF/UEF

Size of elements (watts)

Type of system replaced

Receipt/Proof of Purchase

Choose file

One file only.
20 MB limit.
Allowed types: jpg, png, tif, pdf, doc, docx.

Fridge/Freezer/Washing Machine Rebate

Proof of purchase (receipt)

Choose file

One file only.
20 MB limit.
Allowed types: jpg, png, tif, pdf, doc, docx.

Proof of old appliance haul away/recycling

Choose file

One file only.
20 MB limit.
Allowed types: jpg, png, tif, pdf, doc, docx.

Proof of Energy Star rating (Energy Guide Label)

Choose file

One file only.
20 MB limit.
Allowed types: jpg, png, tif, pdf, doc, docx.

Electric Vehicle Level 2 Charger

Manufacturer

Number of charge ports

Model Name/Number

Receipt/Proof of Purchase

Choose file

One file only.
20 MB limit.
Allowed types: jpg, png, tif, pdf, doc, docx.

Smart Thermostat Rebate

Manufacturer

Proof of Purchase/Receipt

Choose file

Please upload proof of purchase that shows no less than, date purchased, thermostat info including model name and type, and purchase amount.
One file only.
20 MB limit.
Allowed types: jpg, png, tif, pdf, doc, docx.