Fillable 2021 ENERGY STAR LED LIGHTING REBATE APPLICATION (Owatonna Public Utilities)

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2021 ENERGY STAR LED LIGHTING REBATE APPLICATION (Owatonna Public Utilities)

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2021 ENERGY STAR
®
LED LIGHTING REBATE APPLICATION
1 of 3
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
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.
• LED bulbs, LED light fixtures, and ceiling fans with LED lighting must 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.
• The Utility reserves the right to apply rebates to past due accounts. Rebates $75 and under will be applied to your
account. Rebate cannot be combined with any other offer. Rebate cannot exceed the price of the bulb, package, or fixture.
• Recipient must be an electric customer Austin Utilities, Owatonna Public Utilities, or Rochester Public Utilities.
• 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.
o 2. Purchase ENERGY STAR
®
certified LED bulbs, LED light fixtures, and ceiling fans with LED lighting.
o 3. Complete the information on the inside of this rebate booklet, making sure to fill out all sections in detail. Allow 6-8 weeks
for processing. Missing or incorrect information will increase the processing time.
o 4. Include your original sales receipt and 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. Sign the application (required to receive rebate).
o 6.
Information contained in this rebate application may be shared with the Minnesota Department of Commerce and our co-op partners.
o 7. 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 3
When purchasing any type of appliance or equipment, look for the ENERGY STAR
®
or ENERGY STAR
®
Most Efficient logos!
3 of 3
2021 ENERGY STAR
®
LED LIGHTING
OFFICE USE ONLY
Rebate Total: $_____________________
CEILING FANS WITH LED LIGHTING – ENERGY STAR
®
OR ENERGY STAR Most Efficient
®
ENERGY STAR REBATE: 50% of fixture cost, not to exceed $15 per fixture
ENERGY STAR MOST EFFICIENT REBATE: 50% of fixture cost, not to exceed $25 per fixture
MUST INCLUDE PACKAGING WITH ENERGY STAR
®
LOGO, MANUFACTURER, MODEL NUMBER, BULB WATTAGE, AND NUMBER OF FIXTURES.
# of ENERGY STAR (ES) or
A B C D
Fixtures Manufacturer’s Name & ENERGY STAR Most Bulb Location Purchase # of Package Total Rebate Amount
Per Model Number Efficient (ESME)? Wattage
Code Date Packages Price Price (C x 0.50)
Package (check one) (e.g. 12.5W) (see below) (without tax) (A x B) (max $15/ES fixture)
(max $25/ESME fixture)
o
ES
o
ESME
o
ES
o
ESME
Location Codes:
1 = interior, air conditioned • 2 = interior, not air conditioned • 3 = exterior • 4 = various/unknown
OFFICE USE ONLY
Rebate Total: $_____________________
C
OMMER
C
I
A
L
C
U
S
TOMER
S
:
PLE
AS
E
U
S
E
O
U
R
C
O
M
M
E
R
C
I
AL LI
GH
TI
NG R
E
B
A
TE
APPLI
C
A
TI
O
N
LED BULBS & FIXTURES (hardwired; no portable or table lamps) – ENERGY STAR
®
REBATE: 50% of bulb, fixture, or package cost, not to exceed $7 per bulb and $20 per fixture
MUST INCLUDE PACKAGING WITH ENERGY STAR
®
LOGO, MANUFACTURER, MODEL NUMBER, BULB WATTAGE, AND NUMBER OF BULBS.
#
of
A B C D
Bulbs or Manufacturer’s Name & Bulb or Bulb Location Purchase # of Package Price Total Price Rebate Amount
Fixtures Model Number Fixture? Wattage
C
ode Date Packages
(
without tax)
(
A x B)
(
C x 0.50)
P
er
(check one)
(e.g. 12.5W)
(see below) (max $7/bulb)
P
ackage
(max $20/fixture)
o
Bulb
o
Fixture
o
Bulb
o
Fixture
o
Bulb
o
Fixture
o
Bulb
o
Fixture
o
Bulb
o
Fixture
o
Bulb
o
Fixture
o
Bulb
o
Fixture
o
Bulb
o
Fixture
Location Codes:
1 = interior, air conditioned • 2 = interior, not air conditioned • 3 = exterior • 4 = various/unknown
PLEASE PRINT ON RECYCLED PAPER 0121
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2021 ENERGY STAR LED LIGHTING REBATE APPLICATION (Owatonna Public Utilities)

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Completed 8 June 2021

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