Fillable 2021 ENERGY STAR ELECTRIC APPLIANCES REBATE APPLICATION (Owatonna Public Utilities)

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2021 ENERGY STAR ELECTRIC APPLIANCES REBATE APPLICATION (Owatonna Public Utilities)

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2021 ENERGY STAR
®
ELECTRIC APPLIANCES REBATE APPLICATION
1 of 4
SECTION A. CUSTOMER INFORMATION (please print)
Step 1:
Customer Name Account Number
Installation Address City State Zip Code
Mailing Address (if different from installation address) City State Zip Code
o
Home
o
Cell
o
Other:
Contact Phone Number (with area code) E-mail Address
Step 2:
o
Please apply rebate to my account.
o
Please send me a rebate check.
Rebates $75 and under will be applied to your account. If a box is not checked a bill credit will automatically be issued.
Step 3:
How did you hear about CONSERVE & SAVE
®
?
o
Billboard
o
Chamber of Commerce
o
Contractor
o
Newspaper
o
Radio
o
Retailer/Vendor
o
Social Media
o
TV
o
Utility Newsletter
o
Utility Representative
o
Utility Web Site
o
Other _______________________________________________
Step 4:
I am a: My building type is: I am a: My home/business is heated by: My water heating is:
o
Residential Customer
o
Single Family
o
Owner/Occupant
o
Electric
o
Electric
o
Commercial Customer
o
Multi- Family
o
Owner/Non-Occupant
o
Gas
o
Gas
buildings with 2 or more units
o
Renter
o
Don’t Know
o
Don’t Know
OFFICE USE ONLY o Gas o Electric o Water Total Rebate Amount:
Date Received__________________ Date Processed___________________
$
Appliance/Equipment ____________________________________________
ID____________________ Verified By____________________ FILE NAME:__________________________
By typing my first and last names in the CUSTOMER SIGNATURE BOX below, I am signing this document and certify:
o
I have completely filled out Sections A and C
o
I have read, understand, and agree to the terms and conditions – Section B, #1
o
I have attached all support materials – Section B, #3-6
o
All equipment has been installed at the address listed in Section A
CUSTOMER SIGNATURE BOX__________________________________________________ Date_____________
Allow 6-8 weeks
for processing.
Missing or incorrect
information will
increase the
processing time.
MN
MS
MN
MS
SECTION C. CONTRACTOR/RETAILER INFORMATION (please print)
Contractor’s/Retailer’s Name Contact Person Phone Number (with area code)
Installer’s Name (write SELF if customer installed)
Type of Appliance/Equipment Installed
Contractor’s/Retailer’s Name Contact Person Phone Number (with area code)
Installer’s Name (write SELF if customer installed)
Type of Appliance/Equipment Installed
SECTION B. REBATE APPLICATION CHECKLIST
Use this checklist to complete the steps to receive your rebates:
o 1. Read the following terms and conditions to determine if you are eligible for a rebate:
• Only one service address per application.
• Rebates are intended for customers, not contractors or builders.
• The Utility reserves the right to apply rebates to past due accounts. Rebates $75 and under will be applied to your account. Rebates
will not exceed the purchase price.
• Energy-efficient equipment must be connected to an electric service supplied by Austin Utilities, Owatonna Public Utilities, or Rochester
Public Utilities and is subject to inspection.
• Purchase and install
NEW
products. Reconditioned, refurbished, or second-hand equipment is not eligible for a rebate.
•
Equipment installations must meet our Minimum Efficiency Requirements and be
ENERGY STAR
®
certified to qualify for a rebate.
The Utility
reserves the right to reject any rebate application submitted as a result of work performed by a contractor who has failed to adhere to
the terms and conditions established for the rebate program. Contractors must be licensed if applicable.
• Due to limited funding, this rebate offer can be withdrawn at any time without notice. Applications will be processed on a first-come,
first-served basis. All applications from this year’s purchases (2021) must be received by March 31, 2022.
• Rebates can only be offered on equipment that is installed while funding is in effect. In the event our program is discontinued due to
depleted funds, we will not provide a rebate for items installed between the discontinued date and the end of that year.
o 2. Complete the application, making sure to fill out all required sections in detail. Allow 6-8 weeks for processing. Missing or incorrect
information will increase the processing time.
o 3.
Include a final, detailed copy of the original sales receipt, invoice, or picking slip showing the customer name, date of sale, manufacturer
name,
model number, size, and date of installation.
o 4. For LED rebates, applicant must also include the portion of the packaging showing the ENERGY STAR
®
logo, manufacturer, model number,
bulb wattage, and number of bulbs or fixtures. Only one package per each type of bulb and fixture are needed.
o 5. For RECYCLING rebates, applicant must also include proof of recycling from retailer or county recycling center showing the fee paid. The
recycling bonus rebate cannot be combined with any other recycling rebate.
o 6. Sign the application.
o 7.
Information contained in this rebate application may be shared with the Minnesota Department of Commerce and our co-op partners.
o 8. Mail completed forms and required documentation to your utility provider:
Austin Utilities Owatonna Public Utilities Rochester Public Utilities
Attn: Rebate Processing Attn: Rebate Processing Attn: Rebate Processing
1908 14th St NE PO Box 800 4000 E River Rd NE
Austin, MN 55912-4904 Owatonna, MN 55060-0800 Rochester, MN 55906-2813
507-433-8886 507-451-2480 507-280-1500
www.austinutilities.com www.owatonnautilities.com www.rpu.org
or email: rebates@austinutilities.com or email: rebates@owatonnautilities.com or email: rebates@rpu.org
2 of 4
When purchasing any type of appliance or equipment, look for the ENERGY STAR
®
or ENERGY STAR
®
Most Efficient logos!
3 of 4
CLOTHES DRYERS, NATURAL GAS – ENERGY STAR
®
NATURAL GAS DRYER REBATE: $50
(Only available for Austin Utilities and Owatonna Public Utilities. Please see Natural Gas Efficiency Rebate Application.
CLOTHES WASHERS – ENERGY STAR
®
OR ENERGY STAR Most Efficient
®
ENERGY STAR REBATE: $25–$75 ($25 for electric + $25 for water + $25 for natural gas*)
E
NERGY STAR MOST EFFICIENT REBATE: $25–$90 ($40 for electric + $25 for water + $25 for natural gas
*)
CHOOSE ONE:
o
ENERGY STAR
®
o
ENERGY STAR Most Efficient
®
Manufacturer’s Name: Model #:
Number of Units Installed: Date of Installation:
Type of Clothes Dryer:
o
Electric
o
Gas
o
Unknown *Natural Gas Rebate not available from RPU.
DEHUMIDIFIERS – ENERGY STAR
®
PURCHASE REBATE: $15 (no recycling of working unit)
PURCHASE + RECYCLE REBATE: $25 (with proof of non-charged recycling of working unit
)
BONUS RECYCLE REBATE: not to exceed $15 or actual cost (with proof of charge for recycling of working unit
)
MUST INCLUDE RECYCLE RECEIPT FOR BONUS RECYCLE REBATE
Manufacturer’s Name: Model #:
MUST SHOW PROOF OF MODEL # TO QUALIFY FOR REBATE.
Capacity (Pints/Day): Number of Units Installed: Date of Installation:
Why was this purchased? To replace:
o
no previous unit
o
failed unit
o
working unit
IF PURCHASED TO REPLACE A
WORKING UNIT, WAS THE UNIT RECYCLED? o NO
o YES (Must include recycle receipt for rebate.)
IF YES, what was the recycling cost: ________________________
DISHWASHERS – ENERGY STAR
®
OR ENERGY STAR Most Efficient
®
ENERGY STAR REBATE: $25
ENERGY STAR MOST EFFICIENT REBATE: $40
CHOOSE ONE:
o
ENERGY STAR
®
o
ENERGY STAR Most Efficient
®
Manufacturer’s Name: Model #:
Number of Units Installed: Date of Installation:
2021 ENERGY STAR
®
ELECTRIC APPLIANCES
OFFICE USE ONLY
Rebate Total: $_____________________
OFFICE USE ONLY
Electric Rebate Total: $______________
Water Rebate Total: $_______________
Gas
* Rebate Total: $________________
OFFICE USE ONLY
Rebate Total: $_____________________
4 of 4
F
REEZERS – ENERGY STAR
®
REBATE: $25 (no recycling of working unit)
BONUS RECYCLE REBATE: not to exceed $15 or actual cost (with proof of charge for recycling of working unit
)
M
UST INCLUDE RECYCLE RECEIPT
F
OR BONUS RECYCLE REBATE
Manufacturer’s Name: Model #:
Size in Cubic Feet: Number of Units Installed: Date of Installation:
Why was this purchased? To replace:
o
no previous unit
o
failed unit
o
working unit
IF PURCHASED TO REPLACE A
WORKING UNIT, WAS THE UNIT RECYCLED? o NO
o YES (Must include recycle receipt for rebate.)
IF YES, what was the recycling cost: ________________________
REFRIGERATORS – ENERGY STAR
®
REBATE: $25 (no recycling of working unit)
BONUS RECYCLE REBATE: not to exceed $15 or actual cost (with proof of charge for recycling of working unit
)
MUST INCLUDE RECYCLE RECEIPT FOR BONUS RECYCLE REBATE
Manufacturer’s Name: Model #:
Size in Cubic Feet: Number of Units Installed: Date of Installation:
Why was this purchased? To replace:
o
no previous unit
o
failed unit
o
working unit
IF PURCHASED TO REPLACE A
WORKING UNIT, WAS THE UNIT RECYCLED? o NO
o YES (Must include recycle receipt for rebate.)
IF YES, what was the recycling cost: ________________________
ROOM AIR CONDITIONERS – ENERGY STAR
®
REBATE: $25 (no recycling of working unit)
BONUS RECYCLE REBATE: not to exceed $15 or actual cost (with proof of charge for recycling of working unit
)
MUST INCLUDE RECYCLE RECEIPT FOR BONUS RECYCLE REBATE
Manufacturer’s Name: Model #:
MUST SHOW PROOF OF MODEL # TO QUALIFY FOR REBATE
Rated Efficiency (CEER): Size or Capacity (Btu/hr output):
Number of Units Installed: Date of Installation:
DOES THE UNIT HAVE A LOUVERED SIDE? o NO o YES
Why was this purchased? To replace:
o
no previous unit
o
failed unit
o
working unit
IF PURCHASED TO REPLACE A
WORKING UNIT, WAS THE UNIT RECYCLED? o NO
o YES (Must include recycle receipt for rebate.)
IF YES, what was the recycling cost: ________________________
OFFICE USE ONLY
Rebate Total: $_____________________
OFFICE USE ONLY
Rebate Total: $_____________________
OFFICE USE ONLY
Rebate Total: $_____________________
PLEASE PRINT ON RECYCLED PAPER 0121
2021 ENERGY STAR
®
ELECTRIC APPLIANCES
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Completed 8 June 2021

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