White - CenterPoint Energy Yellow - Customer/Purchaser Pink - Dealer/Installer CNP 1283 (1-2018)

WATER HEATER REBATE MISSISSIPPI

Plumber or Installer signature

Installer phoneInstaller name (includes self-installs)

Plumber contact email addressPlumber rebate contact name

Address City/State/ZIP

PLUMBER/RETAILER and INSTALLER INFORMATION (Complete the entire section - please print)

Plumber/Retailer name Dealer ID* (6-digit; leave blank if self-install)

Date

New equipment type (select one) Tankless Tank

AHRI Reference Number

2018 Date of installation Serial number

Model #Brand

EQUIPMENT INFORMATION (To be completed by the plumber or installer)

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

Purchaser's signature

Rebate check mailing address (if different from installation address)

RenterOwner Landlord Builder AgencyPurchaser Type (select one)

Purchaser Email address Alt phonePhone

Check payable to:

Date

City/State/ZIP

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

OtherSit-down Restaurant Warehouse Women Dormitories

Replacement (includes additions / remodel) New constructionType of Installation (select one)

Nursing HomeMen Dormitories Motel Office Building Retail Store

Hospitals LaundromatGrocery 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 address

CenterPoint Energy Gas Account Number where new water heater was installed

City/State/ZIP

Program dates: Jan. 1, 2018 through Dec. 31, 2018

1) Complete the entire application, including required signatures 2) Attach a copy of the detailed sales invoice from the company that installed the water heater or if self-installed, the retailer receipt/invoice. 3) Review the Terms & Conditions on the back of this form to ensure all program requirements are met.

It is the responsibility of the plumber and 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 to participating dealers. If ID is not assigned, rebate can be submitted and dealer should contact us to acquire one.

Return completed form with required signatures and a detailed copy of the dated invoice from plumber/retailer to:

CenterPoint Energy Water Heater Rebate P.O. Box 59038 Minneapolis, MN 55459-0038

WATER HEATER REBATE TERMS & CONDITIONS The qualifying equipment must be installed in a home or business with natural gas service from CenterPoint Energy in Mississippi between January 1 and December 31, 2018. All completed applications must be postmarked by December 31, 2018 to be considered for a rebate. Plumbers/Installers are not eligible to receive their customer's rebate. Builders 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. NOTE: For rebate to apply, new equipment must be listed and Energy Factor (EF) or thermal efficiency verified in the current AHRI (Air Conditioning, Heating and Refrigeration Institute) or ENERGY STAR website. See: ahridirectory.org or energystar.gov/products.

0.68 UEF and greater, High Draw (< 75,000 Btu)

0.80 UEF or greater

0.64 UEF and greater, Medium Draw (< 75,000 Btu)

Energy Factor (EF) according to AHRI

$250

$100

$100

Mail-in Rebate

Tank < 55 gal

$1000.80 UEF and greater, High Draw (< 75,000 Btu)Tank > 55 gal

Tankless

Tank < 55 gal

Type of natural gas water heater

APPLICATION CenterPoint Energy cannot process without all of the requested information on the rebate form and invoice. Work with your dealer, plumber or retailer to complete the entire rebate application and obtain a dated sales invoice showing the detail of what was purchased and installed. The purchaser of the water heater and a representative from your plumber/installer (including self-installs) are required to sign the rebate application.

ATTACH PROOF OF PURCHASE AND INSTALLATION Please include a copy of an itemized receipt and/or invoice(s) with your application. Your plumber/installer or retailer should be able to provide this document for your qualified water heater. Any application missing this will be delayed or denied. PROOF OF PURCHASE AND INSTALLATION DOCUMENTATION MUST INCLUDE THE FOLLOWING:

INSTALLED BY PLUMBER:

● Plumber/Installer or retailer name, address and phone number ● Customer name and installation address

● Itemized listing of quantity, description, manufacturer, complete model number, complete serial number and other identifying information as appropriate

SELF-INSTALLED: ● Itemized sales receipt including retailer name, address, phone number and purchase date

CenterPoint Energy is unable to accept applications that do not include all of the requested information. Application will be returned if any information is missing.

HELP WITH FORMS If you have any questions filling out this form, please contact your plumber or call 888-498-0409 for assistance. If you are building a new home, you must obtain an invoice from your builder or plumber.

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. 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. If you have not received payment after this time, call 888-498-0409 or email RebateCenter@CenterPointEnergy.com. 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 filled in □ Purchaser signature CenterPoint Energy □ Dealer/Installer signature PO Box 59038 □ Dated sales invoice/receipt from the plumber or retailer Minneapolis, MN 55459-0038 to include Customer name, installation address, brand, complete model number and serial number

Signature (Plumber/Installer)X