Fillable 2021 WATER EFFICIENCY REBATE APPLICATION (Owatonna Public Utilities)

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2021 WATER EFFICIENCY REBATE APPLICATION (Owatonna Public Utilities)

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1
2021 WATER EFFICIENCY REBATE APPLICATION
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.
• Water-efficient equipment must be connected to a water service supplied by Austin Utilities, Owatonna Public Utilities, or
Rochester Public Utilities and is subject to inspection.
• Purchase and install NEW products with the WaterSense
®
or ENERGY STAR
®
labels or that meet our minimum efficiency
requirements. Reconditioned, refurbished, or second-hand equipment is not eligible for a rebate.
• Equipment installations must meet our Minimum Efficiency Requirements to qualify for a rebate. WaterSense
®
, ENERGY
STAR
®
, and American Society for Testing and Materials (ASTM) standards are used. (Please refer to the appliance or
equipment rebates sections of this form for requirements and reference sources.) 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.
• 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, and date of installation.
o 4. Sign the application.
o 5.
Information contained in this rebate application may be shared with the Minnesota Department of Commerce and our co-op partners.
o 6. 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
3
CLOTHES WASHERS
(ALSO QUALIFIES FOR AN ELECTRIC AND A GAS REBATE – USE THIS WATER FORM OR AN
MINIMUM EFFICIENCY REQUIREMENTS:
ELECTRIC REBATE FORM OR A GAS REBATE FORM, BUT NOT ALL THREE
)
ENERGY STAR
®
& ENERGY STAR Most Efficient
®
ENERGY STAR REBATE: $25–$75 ($25 for electric + $25 for water + $25 for natural gas*)
ENERGY 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.
SHOWERHEADS – NATURAL GAS ONLY
MINIMUM EFFICIENCY REQUIREMENTS: WATERSENSE
®
LABEL
REBATE: $25 (not to exceed purchase price)
(Only available for Austin Utilities and Owatonna Public Utilities. Please see Natural Gas Efficiency Rebate Application.)
FLUSHOMETER-VALVE TOILETS – COMMERCIAL ONLY
MINIMUM EFFICIENCY REQUIREMENTS: WATERSENSE
®
LABEL
REBATE: $50 PER TOILET
Valve Manufacturer’s Name: Valve Model #:
GPF: Number of Units Installed: Date of Installation:
Why was this purchased? To replace:
o
no previous unit
o
failed unit
o
working unit
Previous Unit Was:
o
1.6 GPF
o
3.5 GPF or greater Rebate Total: $________________________
TOILETS – HIGH EFFICIENCY
MINIMUM EFFICIENCY REQUIREMENTS: WATERSENSE
®
LABEL
REBATE: $25 PER TOILET
Manufacturer’s Name: Bowl Model #: Tank Model #:
GPF: Number of Units Installed: Date of Installation:
Why was this purchased? To replace:
o
no previous unit
o
failed unit
o
working unit Toilet Model #:________________________
Previous Unit Was:
o
1.6 GPF
o
3.5 GPF or greater Rebate Total: $________________________
ALL REBATES ARE AVAILABLE TO RESIDENTIAL & COMMERCIAL CUSTOMERS EXCEPT FOR THOSE MARKED "COMMERCIAL ONLY"
2021
I
ND
OOR
APPL
I
ANCES
&
EQUI
PMENT
OFFICE USE ONLY
Electric Rebate Total: $______________
Water Rebate Total: $_______________
Gas* Rebate Total: $_________________
OFFICE USE ONLY
OFFICE USE ONLY
RAIN BARRELS
MINIMUM EFFICIENCY REQUIREMENTS: MINIMUM SIZE EQUAL TO 40 GALLONS OR GREATER
R
EBATE: $10 PER RAIN BARREL – LIMIT 5 REBATES PER ACCOUNT
Note: If applicant builds own rain barrel(s), rebate may be used for materials.
All receipts for materials, along with a picture of the rain barrel, must be submitted to receive a rebate.
Manufacturer’s Name: Model #:
Gallons of Water Storage per Rain Barrel: Number of Units Installed:
Date of Installation:
Rebate Total: $________________________
WEATHER-BASED IRRIGATION CONTROLLERS
MINIMUM EFFICIENCY REQUIREMENTS: WATERSENSE
®
LABEL
REBATE: 50% OF CONTROLLER COST, NOT TO EXCEED $75 PER CONTROLLER
Manufacturer’s Name: Model #: Number of Units Installed:
Date of Installation: Controller Cost:
Rebate Total: $________________________
4
2021 OUTDOOR EQUIPMENT
A
LL REBATES ARE AVAILABLE TO RESIDENTIAL & COMMERCIAL CUSTOMERS EXCEPT FOR THOSE MARKED "COMMERCIAL ONLY"
PLEASE PRINT ON RECYCLED PAPER 0121
OFFICE USE ONLY
OFFICE USE ONLY
Thank you for purchasing new, efficient appliances and equipment
and for applying for a CONSERVE & SAVE
®
rebate!
When purchasing new items, continue to look for the Energy Star
®
, Energy Star
®
Most Efficient, and WaterSense
®
labels.
By doing so, you will save energy, water, and money while ensuring product performance.
Austin, Owatonna, and Rochester Public Utilities may also offer a CONSERVE & SAVE
®
rebate on your purchase!
For a complete list of available rebates, amounts, and to download rebate applications with
minimum efficiency requirements and complete terms and conditions, visit your utility’s website:
www.austinutilities.com • www.owatonnautilities.com • www.rpu.org
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2021 WATER EFFICIENCY REBATE APPLICATION (Owatonna Public Utilities)

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Completed 8 June 2021

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