Motor/VSD Rebate Form | Highline Electric Association.

Member Info

Member Name

Company

Phone

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Highline Account Number

Legal Description of Installation:

Date of Install

For new product purchases only. Eligible rebate requests must be submitted within 90 days of purchase.
Rebate requests can take 4-8 weeks to receive after submission. Rebate requests must include itemized payment receipts (including model number and/or specification sheet indicating horsepower).
Effective through December 31. Rebate program and products subject to change without notice.
Motor and VSD rebates will be issued as a check.

Select One:

Motor

VSD

Brand/Manufacturer:

Model Number

Nameplate Nominal Efficiency:

New Installation or Replacement/Retrofit?

New Installation

Replacement/Retrofit

Motor Enclosed or Open:

Enclosed

Open

Application:

Motor Type

Equipment Cost (Do not include labor or mis. materials)

Months in Service Per Year:

Motor Nameplate Horsepower:

Motor Speed (RPM):

Itemized Invoice:

*Invoice should include model number and horsepower.

One file only.
20 MB limit.
Allowed types: txt, pdf, doc, docx, ppt, pptx, odp, xls, xlsx, ods.

Picture of Nameplate

One file only.
20 MB limit.
Allowed types: gif, jpg, jpeg, png.