Appliance Rebate Form
Light
and
Power
Name and Address for Rebate
(installation address)
Name:
Mailing Address
(if different from installation address)
Name:
Address:
Address:
Forest Grove, OR 97116
Phone:
Homeowner must supply copy of invoice that provides model number
to verify installation and specifications of unit.
What type of water heater do you have?
Electric
Gas
What type of dryer do you have?
Electric
Gas
Appliance Type Brand Name Model Number Rebate Amount
3 or Energy Star *
(homes w/electric water
$30-$50
(depending on efficiency)
Clothes Washer
(homes w/gas water heater)
$15-$25
Clothes Dryer
$50.00 Energy Star
Heat Pump Water Heater
**
*NOTE: Energy Star top-load washers must have IMEF of 2.38 or greater.
**NOTE:
Heat pump water heater rebate is for replacement of an
electric
storage water heater
I certify this appliance was purchased for installation at above address. I will allow a representative from FGL&P
to verify the installation of the appliance. I understand that rebates are subject to availability of funds and may
change without notice.
Signed:
Date:
Send form and invoice to:
Forest Grove Light and Power
P.O. Box
326
Forest Grove, OR 97116
Or drop off at:
1818 B Street Questions:
(503)992-3250
FOR INTERNAL USE ONLY:
Vendor
No.:
Budget
No.: 6104142-6190/GL927
Ref. No.:
Verified
By:
(INCENTIVES VALID THROUGH 9/30/19)
CITY OF FOREST GROVE P. O. BOX 326
FOREST GROVE, OR 97116
503-992-3200 www.forestgrove-or.gov
