Appliance Rebate Application 6-02-09
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Residential Energy Efficiency Program Appliance Rebate Application Offer valid through September 30, 2009 or until funding expires
APPLICATION INSTRUCTIONS 1. 2. 3. 4.
Complete Application Attach copy of your receipt detailing necessary information Return to Benton PUD within 30 days of purchase Remit completed form to: Benton PUD, 2721 W. 10th Ave., P.O. Box 6270, Kennewick, WA 99336; (509) 582-1234
Applicant Name (please print)
Phone Number
Benton PUD Account #
Installation
Unit/Apt.
City
Zip
Mailing Address
Unit/Apt.
City
Zip FOR BENTON PUD USE ONLY
DESCRIPTION CLOTHES WASHER* ENERGY STAR®
Brand
Model #
Date of Purchase
QTY
Brand
Model #
Date of Purchase
EF68 - RAP00192 EF76 – RAP00195 EF85 – RAP00198
QTY
Brand
Model #
Date of Purchase
RAP00011
QTY
Brand
Model #
Date of Purchase
RWH00019
Please check only one box
$70 Rebate – Heat provided by electric water heater (MEF of >1.8) $25 Rebate – Heat provided by gas water heater (MEF of >1.8) DISHWASHER* ENERGY STAR® $25 Rebate *All qualified ENERGY STAR dishwashers apply
REFRIGERATOR* ENERGY STAR® $25 Rebate
PTR# $70 - RAP00271 $25 - RAP00284
QTY
*All qualified ENERGY STAR refrigerators apply
WATER HEATER* $25 Rebate *Water heaters must be electric *50 – 80 gallon & Energy Factor ratings as follows: 50 gal =.93, 65 gal =.91, 80 gal =.91
By signing below, I certify that all information listed above is true and correct and the installation address is in the Benton PUD service territory. I attest that I have not previously applied for or received a rebate for the appliance listed above. I understand that Benton PUD reserves the right to verify installation of the listed home appliance and that completion of this form does not guarantee my rebate. I acknowledge that Benton PUD’s Appliance Rebate Program is subject to change and funding availability. Applicant Signature__________________________________ Date___________________________ *All rebates are subject to change
FOR BENTON PUD USE ONLY Premise/Invoice Number Approved? Yes No
GL 908.31
Energy Services Vendor ID DEP 45
Resource 117
Verified By/Date Total Amount
Manager Approval / Date
6/2/2009
APPLICATION INSTRUCTIONS 1. 2. 3. 4.
Complete Application Attach copy of your receipt detailing necessary information Return to Benton PUD within 30 days of purchase Remit completed form to: Benton PUD, 2721 W. 10th Ave., P.O. Box 6270, Kennewick, WA 99336; (509) 582-1234
Applicant Name (please print)
Phone Number
Benton PUD Account #
Installation
Unit/Apt.
City
Zip
Mailing Address
Unit/Apt.
City
Zip FOR BENTON PUD USE ONLY
DESCRIPTION CLOTHES WASHER* ENERGY STAR®
Brand
Model #
Date of Purchase
QTY
Brand
Model #
Date of Purchase
EF68 - RAP00192 EF76 – RAP00195 EF85 – RAP00198
QTY
Brand
Model #
Date of Purchase
RAP00011
QTY
Brand
Model #
Date of Purchase
RWH00019
Please check only one box
$70 Rebate – Heat provided by electric water heater (MEF of >1.8) $25 Rebate – Heat provided by gas water heater (MEF of >1.8) DISHWASHER* ENERGY STAR® $25 Rebate *All qualified ENERGY STAR dishwashers apply
REFRIGERATOR* ENERGY STAR® $25 Rebate
PTR# $70 - RAP00271 $25 - RAP00284
QTY
*All qualified ENERGY STAR refrigerators apply
WATER HEATER* $25 Rebate *Water heaters must be electric *50 – 80 gallon & Energy Factor ratings as follows: 50 gal =.93, 65 gal =.91, 80 gal =.91
By signing below, I certify that all information listed above is true and correct and the installation address is in the Benton PUD service territory. I attest that I have not previously applied for or received a rebate for the appliance listed above. I understand that Benton PUD reserves the right to verify installation of the listed home appliance and that completion of this form does not guarantee my rebate. I acknowledge that Benton PUD’s Appliance Rebate Program is subject to change and funding availability. Applicant Signature__________________________________ Date___________________________ *All rebates are subject to change
FOR BENTON PUD USE ONLY Premise/Invoice Number Approved? Yes No
GL 908.31
Energy Services Vendor ID DEP 45
Resource 117
Verified By/Date Total Amount
Manager Approval / Date
6/2/2009
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