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Heat Pump Grant Completion Form
Please enter the approval number of the Belmont Light heat pump grant that was awarded. If you do not have an approval number, you first need to apply for a grant
here
.
*
Indicates required field
Grant Approval Number
*
Belmont Light account holder information
Name
*
First
Last
Phone Number
*
Email
*
Installer information
Company Name
*
Contact Name
*
First
Last
Phone Number
*
Email
*
Address where the heat pump is installed
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Pictures of the manufacturer labels
Pictures of the manufacturer labels on all indoor and outdoor units. The model number and the serial numbers of the equipment should be clearly legible.
Upload Picture 1
*
Max file size: 20MB
Upload Picture 2
*
Max file size: 20MB
Upload Picture 3
*
Max file size: 20MB
Upload Picture 4
*
Max file size: 20MB
Upload Picture 5
*
Max file size: 20MB
Upload Picture 6
*
Max file size: 20MB
Upload Picture 7
*
Max file size: 20MB
Upload Picture 8
*
Max file size: 20MB
Final invoice
Upload the final invoice from the heat pump installer
Upload File
*
Max file size: 20MB
Proof of Registration
Please upload proof that the heat pump equipment has been registered with the manufacturer.
Equipment installed by manufacturer authorized installers and registered with manufacturers typically have longer or more comprehensive warranties than standard warranties.
You may request that proof from your manufacturer authorized installer.
Upload File
*
Max file size: 20MB
Please confirm who the grant should be disbursed to:
*
Belmont Light account holder
Installer
Survey
On a scale of 0 to 10, how likely are you to recommend a heat pump to a friend or colleague?
*
0 - Not likely to recommend
1
2
3
4
5
6
7
8
9
10 - Extremely likely to recommend
On a scale of 0 to 10, how likely are you to recommend the company that installed your heat pump to a friend or colleague?
*
0 - Not likely to recommend
1
2
3
4
5
6
7
8
9
10 - Extremely likely to recommend
On a scale of 0 to 10, how likely are you to recommend the Belmont Light Heat Pump grant program to a friend or colleague?
*
0 - Not likely to recommend
1
2
3
4
5
6
7
8
9
10 - Extremely likely to recommend
Submit
