Dealer Heat Pump Notification Form

Dealer Instructions:

Within two (2) weeks of installation, submit this online Heat Pump Notification Form. Or, send a copy of your customer's invoice, making sure it includes the customer's name, address, installation date, your name, your company name, address and all equipment information as requested below. Mail to: Evergy Billing Services, PO Box 418679, Kansas City, MO 64141-9697, or FAX to (816) 654-1391.

Thank You!

* = Required Field

Customer Information:

Your Name

Evergy Account No

Installation Address

City

State

Zip Code

Primary Phone

Work Phone

Cell Phone

Dealer Information:

Company Name

Dealer Phone

Installation Date

Outdoor Thermostat Setting

(30°F recommended)

Equipment Information:

Is this a new house?
Yes No

Are there multiple heating / cooling systems?
Yes No

Is water heating electric?
Yes No

Old System:

New or Replacement System:

Heat Pump:

Manufacturer

Model Number

Serial Number

Size

SEER

Request For Rate Change:

I certify that an Electric Heat Pump system, or other permanently installed Electric Heat System, has been installed at the above Customer's residence, and that the Customer's electric rate should be changed to a qualifying Electric Heat Rate.

Dealer's Representative