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$40 room air cleaner rebate form
INSTRUCTIONS
1. Purchase an ENERGY STAR® certified room air cleaner
between January 1, 2021 and December 31, 2021.
2. Submit your rebate information online at MassSave.com/Savings or
mail the following to the address at the right before January 31, 2022:
• This complet
ed rebate form
• A copy of the first page of your most recent electric bill
• A copy of the receipt showing the qualifying model, manufacturer,
purchase date, purchase price and store name
DO NOT mail with your utility bill.
Note: To receive your rebate faster,
submit online at MassSave.com/Savings
MAIL TO:
Room air cleaner rebate (MA) • P.O. Box 2528
Manchester, CT 06045
CUSTOMER INFORMATION (FILL CIRCLES COMPLETELY)
Account Holder Name:
Electric Account Number:
Installation Address:
(must match the residential electric account address)
City: State:
MA
ZIP Code:
Phone Number: Email:
Have you had a Home Energy Assessment? Yes No Is this property primarily occupied by the owner or a renter? Owner Renter
MAILING ADDRESS
(IF DIFFERENT FROM ABOVE)
Address: City: State: ZIP Code:
PRODUCT INFORMATION
Visit
MassSave.com/RoomAirCleaner for a list of qualifying products
Product Reba
te Amount Purchase Date Purchase Price Manufacturer Model Number
ENERGY STAR®
Certified
Room Air
Cleaner
$40
_/_ _/_
Store Name:
(where you purchased the room air cleaner)
Store Address: City: State: ZIP Code:
TERMS AND CONDITIONS
Customer Eligibility: Oers valid only for residential electric customers in MA where the Mass Save Program is oered by Cape Light Compact, Eversource, National Grid
and Unitil.
Rebate: Rebate is paid in the form of a Mass Save® Visa® Prepaid card. The card is not redeemable for cash or usable at any ATM. Terms and Conditions apply to the card. Your
card is issued by The Bancorp Bank, Member FDIC, pursuant to a license from Visa® U.S.A. Inc. and can be used everywhere Visa® debit cards are accepted in the U.S. Pay close
attention to the expiration date printed on the front of the card. Card is valid through the last day of the month. You will not have access to the funds after expiration. This rebate
may not be combined with any other utility or energy eciency service provider oer. Please allow 4-6 weeks for application processing. For more information and to check the
status of your rebate, call 1-800-662-9222 or visit MassSave.com/Savings
Installation and Environmental Credits: Customer agrees that the Energy Eciency Program Provider (EEPP) has the unilateral right to apply for any ISO-NE capacity payments
or environmental credits resulting from this energy eciency project, and agrees not to file for such payments or credits either directly or indirectly. The EEPP reserves the right
to conduct field inspections to verify installations.
Liability: Participating utility or energy eciency service provider does not guarantee the performance of installed equipment expressly or implicitly.
Changes to this Rebate Offer: These Terms and Conditions may be changed or terminated by the program administrators at any time without notice.
(!) IMPORTANT: Photocopy your entire submission for your records. You may be required to provide additional copies.
By submitting this rebate, you agree to the above Terms and Conditions.
WE ARE MASS SAVE®:
FOR ADDITIONAL INFORMATION, VISIT MASSSAVE.COM/ROOMAIRCLEANER OR CALL 877-378-2748.
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