Name(Required) First Last URE Account Number(Required) Address(Required) Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Member Consent(Required) I agree toI hereby verify the information to be true and complete and agree to the terms and conditions. I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today’s date and authorized by me as if I had signed my signature. the privacy policy.The Cooperative will offer a geothermal system rebate to encourage the energy efficiency of an approved geothermal heating & cooling system. In order to qualify for the applicable geothermal rebate, the member must agree to carry out the following criteria, insofar as it is applicable to his/her whole house automatic backup heating system. The geothermal system shall be subject to approval and control by the Cooperative in accordance with established rules, regulations, and policies of the Cooperative and shall meet the following criteria: The backup heating system must be capable of maintaining the whole house at a minimum temperature of 65 degrees Fahrenheit for extended periods up to a week or more. A qualified geothermal dealer must install the geothermal system. Only plastic pipe (such as polyethylene or polybutylene) may be used for a loop installation. It is understood that the purchase, installation, maintenance, repair, operability, cost efficiency, merchantability, and fitness for its purpose of any geothermal add-on or conversion unit of any type is the exclusive responsibility of the member (purchaser) and the contractor thereof. The Cooperative does not make any representations or warranties (expressed or implied) regarding a geothermal add-on or conversion unit of any type. A participating contractor will be obligated to provide the member with full operation instructions, owner’s manual, all warranties, installation instructions, and the calculations for sizing the equipment and any necessary ductwork. This agreement remains in effect for 12 years. I, the Cooperative member, acknowledge and disclose that the $800 geothermal rebate for my account is to be mailed directly to me, the Cooperative member. My heating and cooling contractor understands that I am to receive the $800 geothermal rebate. This agreement made and executed on this day between Union Rural Electric Cooperative and Member Name below. Member Electronic Signature (Full Name)(Required) PhoneThis field is for validation purposes and should be left unchanged.
