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HOME
/ PowerShift
PowerShift
Step
1
of
5
20%
Nevada HVAC Contractor Incentive Claim Form
Equipment Information
Measure
(Required)
ASHP Tier 1
ASHP Tier 2
ASHP Tier 3
ASHP Tier 1 - LI
ASHP Tier 2 - LI
ASHP Tier 3 - LI
CAC Tier 1
CAC Tier 2
CAC Tier 3
CAC Tier 1 - LI
CAC Tier 2 - LI
CAC Tier 3 - LI
Ductless Heat Pump
Ductless Heat Pump LI
ES Heat Pump Water Heater
Confirmation Code
(Required)
Product ID (AHRI # or EnergyStar ID)
(Required)
Heating Type
(Required)
Gas
Electric
Outdoor Model Number
Indoor Model Number
Furnace Model Number
Serial Number
Sales Information
Distributor Invoice Number
(Required)
Date of Sale
(Required)
MM slash DD slash YYYY
(from Distributor Invoice)
Installation Date
(Required)
MM slash DD slash YYYY
Retail Price
(Required)
Incentive Amount
(Required)
Home Information
Customer First Name
(Required)
Customer Last Name
(Required)
Installation Address/City/Zip
(Required)
Street Address
City
California
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Customer Address different then Installation?
No
Yes
Customer Contact Address/City/Zip
Street Address
City
California
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Customer Email
(Required)
Customer Phone
(Required)
Building Type
(Required)
Single Family
Multifamily
Existing System Type
(Required)
Central AC
Heat Pump
Storage
Tankless
Building Size
(Required)
Year Built
(Required)
Contractor Information
Contractor Business Name
(Required)
Contractor First Name
(Required)
Contractor Last Name
(Required)
Contractor Phone
(Required)
Contractor Email
(Required)
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