HEAR Appliance Upgrade Program (PON 5859) - Participating Retailer Application

By submitting this application, retailers will be considered for enrollment in NYSERDA’s Appliance Upgrade Program (Program). NYSERDA will evaluate the information provided in this application and if the minimum qualifications are met, the retailer will be invited to sign a Retailer Participation Agreement, which will include all terms and conditions for the Program. 

NOTE: ONLY ONE APPLICATION MUST BE SUBMITTED FOR EACH RETAILER COMPANY.

Before beginning:

• Be aware that partially completed information cannot be saved.
• Be sure to have all documents in your possession before beginning the form.​

  • Certificate of Insurance - Upload copy of your Certificate of Insurance (COI). This form should list “NYSERDA and the State of New York” as named insured. NYSERDA requires a COI for any company that NYSERDA does business with.

  • IRS W-9 Form - Upload your most recent IRS W-9 form, so NYSERDA can complete your company’s profile. This information is considered confidential and will be categorized as such. The W-9 will be used for vendor/payee details to facilitate reimbursement of redeemed rebate coupons.

  • New Supplier ID Form - Download the New Supplier ID Form. This form allows NYSERDA to set you up as a vendor in our Accounts Payable System to ensure the accuracy of NYSERDA payments issued. Please fill-out the form and upload it on the Upload section below.

• For the best form completion experience, use the Google Chrome browser.

No communication intended to influence this procurement is permitted except by contacting Ryan Moore, Senior Project Manager at (518) 862-1090, ext. 3267, Nicole Munz, Project Manager or Chris Corcoran, Assistant Director (for technical questions). Email contact regarding technical questions is only permitted through IRAretail@nyserda.ny.gov.

Answer the following questions about your company and designated contact (applicant).

Answer the questions below based on the Program appliance types (ENERGY STAR® certified: heat pump clothes dryers, induction stoves/cooktops/ranges/ovens and all-in-one washer-dryers (heat pump dryer)) that are sold at your brick-and-mortar stores in New York State (NYS) and/or online.

Please ensure your document file name does not include any special characters, such as ~! @#$%^&*_-+=`|\(){}[]:;"'<>,.?/. 

For the following questions, choose one option that best fits the delivery services offered by your company for the available appliance types selected in the above Section. 

Answer the following set of questions and choose one answer that best fits the services your company provides. For this section and the following, NYSERDA is collecting this information to better understand the services offered to customers. Please note that while delivery is a required service to participate in this program, retailers are not required to provide installations.  

Note: Enrollment for Participating Contractors will be done through a modification of this open solicitation and a separate application.

For each point-of-sale system in your brick-and-mortar stores, answer the following questions on technology requirements. Select "Yes" or "No".

Outlined below are the key components of the “non-connected” Participating Retailer path, which is further detailed in the Program Manual. After reviewing the path and criteria, select “Yes” or “No” to confirm or deny that your company can adhere to this process. 

1. Create a maximum number of 10 users in the NYSERDA MyEnergy portal to maintain the following process. 

2. Create two batches of coupons based on the criteria outlined in the Program Manual.  

3. Upload coupon batches to the NYSERDA MyEnergy portal per request by NYSERDA’s Implementation Contractor (IC).  

4. Validate, apply and void the coupon presented by the program participant at the time of purchase. 

5. Within 30 days of coupon(s) redemption, submit the required transaction data (outlined in the Program Manual) to NYSERDA through the MyEnergy portal. Note: this data will be sent to the U.S. Department of Energy for required reporting purposes. 

6. If necessary, rectify any documentation issues noted by NYSERDA’s IC to receive coupon(s) reimbursement. 

Please upload copy of your Certificate of Insurance (COI). This form should list “NYSERDA and the State of New York” as named insured. NYSERDA requires a COI for any company that NYSERDA does business with.

Please upload your most recent IRS W-9 form, so NYSERDA can complete your company’s profile. This information is considered confidential and will be categorized as such. The W-9 will be used for vendor/payee details to facilitate reimbursement of redeemed rebate coupons.

Please download the New Supplier ID Form. This form allows NYSERDA to set you up as a vendor in our Accounts Payable System to ensure the accuracy of NYSERDA payments issued. Please fill-out the form and upload below.