Fillable Appliance Rebate Form (Otter Tail Power Company)

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Appliance Rebate Form (Otter Tail Power Company)

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Customer Name (as it appears on electric bill): Cell Phone: Home Phone: Email:
Installation Address
(where equipment is installed):
City: State: ZIP:
Mailing Address
(if different than above): City: State: ZIP:
Preferred method of follow-up communication:
q Postal mail q Email q Home phone q Cell phone
Electric Utility Account Number
(found on monthly bill): Property Type (check all that apply):
q Single-Family q Apartment q Townhouse
q Mobile Home q Other
Rental Property:
q Yes q No
Does home have central AC?
q Yes q No
Water heating fuel type:
q Natural Gas q Electric q Propane q Oil q Other________________________
Primary fuel for home heating (check one):
q Natural Gas q Electric q Propane q Oil q Other________________
Check one:
q Existing home q New construction
SECTION 1: Customer Information
This application is for qualied items purchased and installed between January 1, 2022 and December 31, 2022. Completed applications must be received by March 31, 2023.
800.969.9322 otpco.com
REV: 12102021
1
2022 ENERGY STAR
®
Appliance Rebate Form
Eligible Items Program Qualications
Date
Installed
Incentive
Amount
Quantity
Total
Incentive*
Refrigerator
(size must be ≥ 7.75 cu ft)
ENERGY STAR qualied. Limit 1 per install address. Compact fridge excluded.
q Side by Side q Top Freezer q Bottom Freezer q Single Door
Manufacturer:__________________________________________________________
Model #:_______________________________________________________________
$50 $
Chest Freezer or
Upright Freezer
(size must be ≥ 7.75 cu ft)
ENERGY STAR qualied. Limit 1 per install address.
Manufacturer:__________________________________________________________
Model #:_______________________________________________________________
$50 $
Dishwasher
ENERGY STAR qualied. Limit 1 per install address.
Manufacturer:_________________________________________________________
Model #:______________________________________________________________
$50 $
Clothes Washer
ENERGY STAR qualied. Limit 1 per install address.
Manufacturer:__________________________________________________________
Model #:_______________________________________________________________
$50 $
Clothes Dryer
ENERGY STAR qualied. Limit 1 per install address. Must be electric.
Limit 1 per install address.
Manufacturer:__________________________________________________________
Model #:_______________________________________________________________
$50 $
TOTAL REQUESTED:
$
SECTION 2: Electric Measures Products must be new and in working condition. Refurbished products are not eligible for incentives.
Submit your application to: Otter Tail Power Appliance Rebate, 431 Charmany Drive, Madison, WI 53719 Fax: 608.646.7682 email: otpcorebates@slipstreaminc.org
Signature
The ENERGY STAR Appliance Rebate Application cannot be processed unless all of the appropriate elds on this application are complete. This application is valid for
products installed between January 1, 2022 and December 31, 2022. I have read and understand the Terms and Conditions. I certify the information I have provided
is true and correct, and the product(s) for which I am requesting an incentive meets the requirements in this application. I have elected to utilize electronic signatures.
I understand and intend that a legal signature is formed by typing my name on this document. If any of the parties do not wish to sign this document electronically, all
must opt out together and print a paper copy to sign manually.
Customer Signature: Print Name:
Terms and Conditions
800.969.9322 otpco.com
REV:12102021
2
2022 ENERGY STAR
®
Appliance Rebate Form
Submit your application to: Otter Tail Power Appliance Rebate, 431 Charmany Drive, Madison, WI 53719 Fax: 608.646.7682 email: otpcorebates@slipstreaminc.org
TO RECEIVE YOUR
REBATE
ONLINE
Visit https://www.otpco.com/ways-to-save/
rebates-and-savings/appliance-rebates/ to ll out
the online rebate application. Online application
process is for Otter Tail Power customers only.
OR
MAIL
Mail in completed rebate form with a copy of your
dated sales receipt.
Mail to: Otter Tail Power Appliance Rebate
431 Charmany Drive, Madison, WI 53719
This program is available to Otter Tail Power
Company MN residential and small commercial
customers who have installed qualifying electric
refrigerators, freezers, dishwashers, clothes
washers, and clothes dryers.
Our program requires you to submit a completed
rebate application and a dated sales receipt/
invoice, circling the purchase price, before Otter Tail
Power Company can issue a rebate.
Otter Tail Power Company issues cash rebates in the
form of checks, not energy bill credits. Allow 6 to 8
weeks for rebate processing.
Otter Tail Power Company reserves the right to limit
any rebate. Acceptance of the application does not
guarantee payment of a rebate. You will be notied
if your application has not been accepted, pending
nal review.
Qualications for a rebate does not imply any Otter
Tail Power Company representation or warranty of
any work performed. Otter Tail Power Company also
does not warrant that actual energy savings will
be equal to the contractor’s estimate. Customer
agrees that Otter Tail Power Company shall not
be responsible or liable for any personal injury to
property damage caused by installation. The rebate
program is subject to change or cancellation without
notice.
Please visit us at www.otpco.com or call our Idea
Center at 800-493-3299 to determine whether any
program changes have occurred.
Qualifying customers
This program is available to Otter Tail Power
Company MN residential and small commercial
customers who have installed qualifying electric
refrigerators, freezers, dishwashers, clothes
washers, and clothes dryers.
Rebate details
Customer requesting a rebate must purchase and
install a new Energy Star rated refrigerator, freezer,
clothes washer, and/or electric clothes dryer.
Compact-sized appliances and appliances not rated
as Energy Star do not quality. Size of refrigerator or
freezer must be greater than or equal to 7.75 cu ft.
This program will provide a rebate of $50 for the
installation of qualifying appliances. Customers
are eligible for rebates for any combination of
appliances, but no more than one appliance type
per year.
Qualifying equipment must be purchased and
installed prior to December 31 to qualify for a
current year rebate. Rebates on applications
received after December 31 are subject to change.
Rebate applications received after March 31, 2023
for prior year installations will not qualify for a
rebate.
Otter Tail Power Company reserves the right to deny any rebate which does not meet program guidelines included on this application. Program may be discontinued or modified at any time.
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Appliance Rebate Form (Otter Tail Power Company)

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Completed 30 May 2022

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