Fillable 2022 RESIDENTIAL REBATE APPLICATION

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2022 RESIDENTIAL REBATE APPLICATION

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2022 RESIDENTIAL REBATE APPLICATION
Name______________________________________________ Account # ____________________________
Address____________________________________________________________________________________
City___________________________ State__________ ZIP_____________ Phone ______________________
Member Type
Homeowner
Primary Heating System? (must check one)
Landlord
Electric
Builder
Fossil Fuel
Other
Other
Integrated ECM Integrated Water Heater Open Loop
Closed Loop
New GSHP
Replacement GSHP
MEMBER INFORMATION
Contractor Information
Company Name __________________________________________________ Phone ___________________
Contractor Signature ______________________________________________ Today’s Date ______________
I certify that the product for which a rebate is being claimed is a qualifying appliance; it has been or will be installed at the
member address listed above; and this address represents a valid ECE account.
Rebate form cannot be processed
without contractor signature.
Rev. 1/22
1.800.254.7944 | eastcentralenergy.com
East Central Energy is an equal opportunity provider and employer.
Member Signature____________________________________________ Today’s Date___________________
By signing this application, I certify the rebates I am claiming are qualifying ENERGY STAR® rated products and are
installed at the address listed above which represents a valid ECE account.
APPLIANCE REBATES (must be ENERGY STAR rated)
New Refrigerator: Manufacturer _______________________ Model Number ____________________________
Rebate Amount $25 (Receipt for both purchase of new unit and recycling of existing unit required)
New Freezer: Manufacturer ___________________________ Model Number ____________________________
Rebate Amount $25 (Receipt for both purchase of new unit and recycling of existing unit required)
Dehumidifier: Manufacturer __________________________ Model Number____________________________
Rebate Amount $25 (Receipt for purchase of new unit required)
Ductless Air Source Heat Pump: Manufacturer _____________________________________________________
Rebate Amount $400 (Receipt for purchase is required)
Indoor Model Number _________________________ Outdoor Model Number_________________________
Indoor Model Number _________________________ Outdoor Model Number_________________________
Wi-Fi Enabled Thermostat
Wi-Fi Enabled Thermostat: Manufacturer_________________ Model Number__________________________
Rebate Amount $25 (Receipt for purchase is required)
GEOTHERMAL Ground Source Heat Pump (GSHP) ***Contractor Signature Required
Rebate $400 per ton (Receipt for purchase and contractor invoice are required)
Manufacturer _________________________Model Number _______________________________ Tons______
Check all that apply:
• Limit one rebate per appliance type per member account.
• Appliance/products must be installed in 2022 within ECE territory.
• Rebates will be awarded on a first-come, first-served basis.
• Fill out form completely. Incomplete forms will not be processed.
• Include your account number, sign, and have contractor sign when applicable.
• Receipt or contractor invoice must include model number.
• Rebate will be issued as a credit on your ECE account if under $1,000.
• Allow 6-8 weeks for processing.
Submit completed rebate form and a copy of the original sales
receipt by December 31, 2022.
East Central Energy
Attention: Energy Services Rebates
P.O. Box 39
Braham, MN 55006
For ENERGY STAR products, rebates are only available for new ENERGY STAR rated products purchased between January
1 – December 31, 2022. Supported documents must be submitted by December 31, 2022. The products must be
installed where electricity is supplied by ECE. Rebate submittal must follow the guidelines as outlined by ECE. ECE is not
responsible for inaccurate information supplied by appliance/product dealers. Rebates will be issued only for products
on the current list of ENERGY STAR rated products as of the purchase date. ENERGY STAR occasionally removes products
from qualifying lists, and ECE will not rebate products that have been unlisted as of the purchase date or are mislabeled
as ENERGY STAR. To verify ENERGY STAR certification for appliances, visit energystar.gov or call 1-888-STAR-YES. Rebate
program is subject to change or cancellation without notice. To verify rebate program status call ECE at 1.800.254.7944.
PLEASE review before you submit your rebate application.
IMPORTANT INFORMATION
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2022 RESIDENTIAL REBATE APPLICATION

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Completed 25 April 2022

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