Clothes Dishwasher Rebate Form09
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How did you hear about SMUD rebates? Advertising (billboard, magazine, newspaper, radio, TV, non-Smud website)? Other
SMUD Bill Package
SMUD Website
Letter from SMUD
Sales Associate
2009 APPLIANCE REBATE APPLICATION ENERGY STAR
Refer to page 2 of this form for instructions on how to submit application.
RATE
SMUD TRANSACTION NO.
WATER HEAT CODE
APPLICANT INFORMATION Property Type: Detached Home
Attached Home
Condominium
Mobile Home
SMUD ACCOUNT NUMBER (Installation Address)
If mobile home, please provide Park Name: Address:
City:
Zip:
CUSTOMER/PURCHASER NAME (Check Payable To)
TENANT NAME (if different)
MAILING ADDRESS (Check To Be Mailed To)
INSTALLATION ADDRESS (If different)
CITY / STATE / ZIP CODE (Check To Be Mailed To)
CITY / STATE / ZIP CODE
HOME PHONE
(
WORK PHONE
)
(
TENANT HOME PHONE
)
(
TENANT WORK PHONE
)
(
)
Complete all information requested below and attach sales receipt for all products purchased and installed. Rebate Eligibility Requirements Subject to modification or termination due to available funds
Rebate Amount Purchase Product Information
Total Rebate
HOUSEHOLD WATER HEATER MUST BE ELECTRIC To qualify for the SMUD Clothes Washer or Dishwasher rebate, the water heater providing water to the clothes washer or dishwasher must be electric. If you have a gas water heater, please contact your local gas utility for rebate information .
CEE-rated ENERGY STAR ® Clothes Washer • Must meet the Consortium for Energy Efficiency (CEE) criteria. Not all ENERGY STAR® qualified clothes washers may meet this criteria.
$ 100/unit for Tier 1 $ 200/unit for Tier 2 & 3 Tier
HOUSEHOLD WATER HEATER MUST BE ELECTRIC.
• Internal electric water heater in unit does not qualify as electric water heating Must be Tier source. Must meet eligibility list (based on Modified Energy Factor & Water 1, 2, 3 Factor efficiency). 1 Per Address, Per Year
Make
• For a SMUD list of eligible Clothes Washers, visit www.smud.org or
Store Name
Model No.
call 1-888-742-SMUD (7683). NOTE: Most local appliance stores will have eligible product list.
Date Purchased
CEE-rated ENERGY STAR® Dishwasher
$ 30/unit for Tier 1 $ 50/unit for Tier 2 & compact
• Must meet the Consortium for Energy Efficiency (CEE) criteria. Not all ENERGY STAR® qualified dishwashers may meet this criteria.
HOUSEHOLD WATER HEATER MUST BE ELECTRIC.
• HOUSEHOLD WATER HEATER MUST BE ELECTRIC. Internal electric water heater in unit does not qualify as electric water heating source. Must meet eligibility Tier list (based on energy factor efficiency) criteria. 1 Per Address, Per Year • For a list of eligible Dishwashers, visit www.smud.org or call 1-888-742-SMUD (7683). NOTE: Most local appliance stores will have eligible product list.
$
Make
Must be Tier 1or 2
Model No.
$
Store Name Date Purchased
An on-site verification or additional documentation may be requested by a SMUD representative prior to approval of rebate payment.
Total Rebate Amount - $ I certify by my signature: (1) I have purchased the product(s) that meet the Residential Rebate Eligibility Requirements set forth by SMUD; (2) I have read and understand all information of the Terms and Conditions set forth by SMUD; and (3) I have provided information that is true and correct.
Customer’s Signature
Print Name
Date
SMUD USE ONLY PK
40 40
DESCRIPTION
CLOTHES WASHER REBATE DISHWASHER REBATE
AMOUNT
ELEMENT
ORDER
540120 540120
4007768 4007769
TOTAL REBATE PAID © SMUD-1918c (1 of 2) 5/09 Forms Management SACRAMENTO MUNICIPAL UTILITY DISTRICT ®
A registered service mark of Sacramento Municipal Utility District.
The Power To Do More.®
HD - Web
HOW TO SUBMIT 2009 APPLIANCE REBATE APPLICATION 1. Read the Terms and Conditions listed below. 2. Ensure all information is correct, legible, and the customer/purchaser signs the rebate application. Provide mailing address (if different from installation address) of the person applying for the rebate. Incomplete application will be returned to customer/purchaser. 3. Mail a current copy of the SMUD electric bill that identifies the installation address and account number of the location where the purchased product is installed. 4. Mail completed and signed rebate application form within 60-days of purchase date, along with a legible copy of the sales receipts that clearly identifies the appliance store name, product make, model number, purchase price and date of purchase to: SMUD-Residential Services Appliance Rebate Program, MS A203 P.O. Box 15830 Sacramento, CA 95852-1830 IMPORTANT - Applicants are advised to retain a copy of this form, sales receipt and any applicable material submitted to SMUD under this program for your records. SMUD will not be responsible for lost or damaged documentation pertaining to this rebate application request.
TERMS and CONDITIONS 1. Effective date of program is January 1, 2009. Only purchases made on or after the start date are eligible. The program end date is December 31, 2009, or until funding is depleted. 2. Customer/Purchaser agrees that the appliance product purchased must be for primary use in a residence or business with an active meter receiving SMUD electric service. 3. Rebates are based on energy efficiency levels described under the Residential Rebate Eligibility Requirement (listed on page 1 for each product). The District expressly reserves the right to modify, amend or terminate the appliance rebate program, in whole or in part, at anytime and for any reason without prior notice. Call 1-888-742-SMUD (7683) to obtain current rebate program information. 4. The rebate amount cannot exceed the purchase price nor can a rebate be received for the same product/equipment from more than one utility participating in this program or other third party programs funded with CPUC Public Goods Charge funds. 5. Rebate application must be postmarked within 60-days of the date of purchase or customer/purchaser may not be able to apply for and/or receive any rebate allowances for such purchase(s). Failure to provide appropriate documentation may result in appliance rebate ineligibility, including but not limited to all rebates and incentives. 6. Product must be NEW/Undamaged and installed at a residential or business location within SMUD’s service area. Products that are resale, rebuilt, rented, leased, exchanged, won as a prize, or new parts installed into existing products are not eligible for rebate. NOTE: To qualify for the Clothes Washer and/or Dishwasher rebate, the household water heating source must be ELECTRIC. Internal electric water heater in unit does NOT qualify as electric water heating source. 7. Customer is solely responsible for installation of all rebated products to the manufacturer’s specifications. Customer is solely responsible for obtaining related building permits and completing the inspection process as required by local jurisdiction. 8. Customer/Purchaser agrees that SMUD reserves the right to inspect the installation premises or request additional documentation prior to rebate payment. Rebate may be denied by SMUD if this condition is not met by customer/purchaser. 9. Each individual executing this agreement on behalf of a party represents and warrants that he or she is duly authorized to execute and deliver this agreement on behalf of said party. 10. Disclaimer of Warranties: SMUD makes no representations, expressed or implied, regarding the design, installation, construction, reliability, efficiency, performance, operation, maintenance, or use of any energy efficiency equipment or systems analyzed, discussed, selected, rejected, installed or otherwise considered by customer. Any decisions regarding the selection, design, installation, use and operation of any energy efficiency equipment or systems shall be at the sole discretion and are the sole responsibility of the customer. 11. Customer/Purchaser shall indemnify, defend, and hold harmless SMUD, its directors, officers, agents, and employees against all claims, loss, damage, expense, and liability asserted or incurred by other parties, including but not limited to SMUD’s employees and Purchaser’s employees, arising out of or in any way connected with the performance of the agreement and caused by the acts, omissions, intent or negligence, whether active or passive, or purchaser, its agents, employees, and suppliers, and excepting only such loss, damage, or liability as may be caused by the intentional act or the sole negligence of SMUD. NOTE: Rebate checks will be mailed 8-10 weeks subsequent to receiving all required documentation. Applications are processed on a first-come, first-served basis. © SMUD-1918c (2 of 2) 5/09 Forms Management
HD - Web
SMUD Bill Package
SMUD Website
Letter from SMUD
Sales Associate
2009 APPLIANCE REBATE APPLICATION ENERGY STAR
Refer to page 2 of this form for instructions on how to submit application.
RATE
SMUD TRANSACTION NO.
WATER HEAT CODE
APPLICANT INFORMATION Property Type: Detached Home
Attached Home
Condominium
Mobile Home
SMUD ACCOUNT NUMBER (Installation Address)
If mobile home, please provide Park Name: Address:
City:
Zip:
CUSTOMER/PURCHASER NAME (Check Payable To)
TENANT NAME (if different)
MAILING ADDRESS (Check To Be Mailed To)
INSTALLATION ADDRESS (If different)
CITY / STATE / ZIP CODE (Check To Be Mailed To)
CITY / STATE / ZIP CODE
HOME PHONE
(
WORK PHONE
)
(
TENANT HOME PHONE
)
(
TENANT WORK PHONE
)
(
)
Complete all information requested below and attach sales receipt for all products purchased and installed. Rebate Eligibility Requirements Subject to modification or termination due to available funds
Rebate Amount Purchase Product Information
Total Rebate
HOUSEHOLD WATER HEATER MUST BE ELECTRIC To qualify for the SMUD Clothes Washer or Dishwasher rebate, the water heater providing water to the clothes washer or dishwasher must be electric. If you have a gas water heater, please contact your local gas utility for rebate information .
CEE-rated ENERGY STAR ® Clothes Washer • Must meet the Consortium for Energy Efficiency (CEE) criteria. Not all ENERGY STAR® qualified clothes washers may meet this criteria.
$ 100/unit for Tier 1 $ 200/unit for Tier 2 & 3 Tier
HOUSEHOLD WATER HEATER MUST BE ELECTRIC.
• Internal electric water heater in unit does not qualify as electric water heating Must be Tier source. Must meet eligibility list (based on Modified Energy Factor & Water 1, 2, 3 Factor efficiency). 1 Per Address, Per Year
Make
• For a SMUD list of eligible Clothes Washers, visit www.smud.org or
Store Name
Model No.
call 1-888-742-SMUD (7683). NOTE: Most local appliance stores will have eligible product list.
Date Purchased
CEE-rated ENERGY STAR® Dishwasher
$ 30/unit for Tier 1 $ 50/unit for Tier 2 & compact
• Must meet the Consortium for Energy Efficiency (CEE) criteria. Not all ENERGY STAR® qualified dishwashers may meet this criteria.
HOUSEHOLD WATER HEATER MUST BE ELECTRIC.
• HOUSEHOLD WATER HEATER MUST BE ELECTRIC. Internal electric water heater in unit does not qualify as electric water heating source. Must meet eligibility Tier list (based on energy factor efficiency) criteria. 1 Per Address, Per Year • For a list of eligible Dishwashers, visit www.smud.org or call 1-888-742-SMUD (7683). NOTE: Most local appliance stores will have eligible product list.
$
Make
Must be Tier 1or 2
Model No.
$
Store Name Date Purchased
An on-site verification or additional documentation may be requested by a SMUD representative prior to approval of rebate payment.
Total Rebate Amount - $ I certify by my signature: (1) I have purchased the product(s) that meet the Residential Rebate Eligibility Requirements set forth by SMUD; (2) I have read and understand all information of the Terms and Conditions set forth by SMUD; and (3) I have provided information that is true and correct.
Customer’s Signature
Print Name
Date
SMUD USE ONLY PK
40 40
DESCRIPTION
CLOTHES WASHER REBATE DISHWASHER REBATE
AMOUNT
ELEMENT
ORDER
540120 540120
4007768 4007769
TOTAL REBATE PAID © SMUD-1918c (1 of 2) 5/09 Forms Management SACRAMENTO MUNICIPAL UTILITY DISTRICT ®
A registered service mark of Sacramento Municipal Utility District.
The Power To Do More.®
HD - Web
HOW TO SUBMIT 2009 APPLIANCE REBATE APPLICATION 1. Read the Terms and Conditions listed below. 2. Ensure all information is correct, legible, and the customer/purchaser signs the rebate application. Provide mailing address (if different from installation address) of the person applying for the rebate. Incomplete application will be returned to customer/purchaser. 3. Mail a current copy of the SMUD electric bill that identifies the installation address and account number of the location where the purchased product is installed. 4. Mail completed and signed rebate application form within 60-days of purchase date, along with a legible copy of the sales receipts that clearly identifies the appliance store name, product make, model number, purchase price and date of purchase to: SMUD-Residential Services Appliance Rebate Program, MS A203 P.O. Box 15830 Sacramento, CA 95852-1830 IMPORTANT - Applicants are advised to retain a copy of this form, sales receipt and any applicable material submitted to SMUD under this program for your records. SMUD will not be responsible for lost or damaged documentation pertaining to this rebate application request.
TERMS and CONDITIONS 1. Effective date of program is January 1, 2009. Only purchases made on or after the start date are eligible. The program end date is December 31, 2009, or until funding is depleted. 2. Customer/Purchaser agrees that the appliance product purchased must be for primary use in a residence or business with an active meter receiving SMUD electric service. 3. Rebates are based on energy efficiency levels described under the Residential Rebate Eligibility Requirement (listed on page 1 for each product). The District expressly reserves the right to modify, amend or terminate the appliance rebate program, in whole or in part, at anytime and for any reason without prior notice. Call 1-888-742-SMUD (7683) to obtain current rebate program information. 4. The rebate amount cannot exceed the purchase price nor can a rebate be received for the same product/equipment from more than one utility participating in this program or other third party programs funded with CPUC Public Goods Charge funds. 5. Rebate application must be postmarked within 60-days of the date of purchase or customer/purchaser may not be able to apply for and/or receive any rebate allowances for such purchase(s). Failure to provide appropriate documentation may result in appliance rebate ineligibility, including but not limited to all rebates and incentives. 6. Product must be NEW/Undamaged and installed at a residential or business location within SMUD’s service area. Products that are resale, rebuilt, rented, leased, exchanged, won as a prize, or new parts installed into existing products are not eligible for rebate. NOTE: To qualify for the Clothes Washer and/or Dishwasher rebate, the household water heating source must be ELECTRIC. Internal electric water heater in unit does NOT qualify as electric water heating source. 7. Customer is solely responsible for installation of all rebated products to the manufacturer’s specifications. Customer is solely responsible for obtaining related building permits and completing the inspection process as required by local jurisdiction. 8. Customer/Purchaser agrees that SMUD reserves the right to inspect the installation premises or request additional documentation prior to rebate payment. Rebate may be denied by SMUD if this condition is not met by customer/purchaser. 9. Each individual executing this agreement on behalf of a party represents and warrants that he or she is duly authorized to execute and deliver this agreement on behalf of said party. 10. Disclaimer of Warranties: SMUD makes no representations, expressed or implied, regarding the design, installation, construction, reliability, efficiency, performance, operation, maintenance, or use of any energy efficiency equipment or systems analyzed, discussed, selected, rejected, installed or otherwise considered by customer. Any decisions regarding the selection, design, installation, use and operation of any energy efficiency equipment or systems shall be at the sole discretion and are the sole responsibility of the customer. 11. Customer/Purchaser shall indemnify, defend, and hold harmless SMUD, its directors, officers, agents, and employees against all claims, loss, damage, expense, and liability asserted or incurred by other parties, including but not limited to SMUD’s employees and Purchaser’s employees, arising out of or in any way connected with the performance of the agreement and caused by the acts, omissions, intent or negligence, whether active or passive, or purchaser, its agents, employees, and suppliers, and excepting only such loss, damage, or liability as may be caused by the intentional act or the sole negligence of SMUD. NOTE: Rebate checks will be mailed 8-10 weeks subsequent to receiving all required documentation. Applications are processed on a first-come, first-served basis. © SMUD-1918c (2 of 2) 5/09 Forms Management
HD - Web
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