Heat Pump Form

DEALER INSTRUCTIONS:
Within two (2) weeks of installation, submit this online Heat Pump Notification Form. All titles in red below are required. 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 KCP&L Billing Services, PO Box 418679, Kansas City, MO 64141-9697, or FAX to (816)654-1391. THANK YOU!

Customer Information:
Name:		KCP&L Account No:
Installation Address: City:		State: Zip:
Phone Home: or Work: or Cell:

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: (Required, if not a new house)

A/C - Gas Furnace	A/C - Elec Furnace	Total Elec HP	Dual Fuel HP - Gas Furnace
Gas Boiler	Other: [Radiant, Base Board, etc.]

NEW OR REPLACEMENT SYSTEM: (Required)
Dual Fuel HP	Total Elec HP	Geothermal HP	HP added to Elec Furnace
Electric Boiler	Other: [Radiant, Base Board, etc.]

HEAT PUMP	Manufacturer	Model Number	Serial Number	Size(Tons)	SEER
First Unit
Second Unit
Additional Unit
Additional Unit

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:

* Submitting is an Electronic Signature

Kansas City, Missouri