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PSO Home Rebates – Multiple Upgrades Inspection Request
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Test-In
Test-Out
Homeowner's Name:
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Address:
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City:
State:
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip:
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Homeowner's Phone:
Homeowner's Email:
Preferred Method of Contact:
Email
Phone
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Service Provider's Company Name:
Service Provider's Contact Name:
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Service Provider's Email:
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Approved Efficiency Upgrades (select all that apply):
Air Infiltration
Air Conditioner System 1
SEER:
16
17
18
20+
Air Conditioner System 2
SEER:
16
17
18
20+
Air Conditioner System 3
SEER:
16
17
18
20+
Electronically Communicated Motor
Duct Replacement System 1
Size in Tons:
1.5-2
2.5-3
3.5-4
4.5-5
Duct Replacement System 2
Size in Tons:
1.5-2
2.5-3
3.5-4
4.5-5
Duct Replacement System 3
Size in Tons:
1.5-2
2.5-3
3.5-4
4.5-5
Duct Sealing System 1
Size in Tons:
1.5-2
2.5-3
3.5-4
4.5-5
Duct Sealing System 2
Size in Tons:
1.5-2
2.5-3
3.5-4
4.5-5
Duct Sealing System 3
Size in Tons:
1.5-2
2.5-3
3.5-4
4.5-5
Attic/Ceiling Insulation
Knee Wall Insulation
Other:
Notes:
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I verify that I have or will follow all applicable rules and standards for PSO's Home Rebates while evaluating the above homeowner’s home, formulating comprehensive recommendations and proposals, and conducting any work resulting from those recommendations. I also certify that the information contained in this form, in the Service software record, and in any contract material submitted for review, is true and complete to the best of my knowledge.
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