Energy Star Appliance Rebate

Washers Certified* Dishwashers Refrigerators Freezers

Residential Rebate for

$50 $50 $50 $25

Please Print

Rebate eligible appliances must be currently listed* on the official www.energystar.gov website.

*Please see Side 2 for information on official ENERGY STAR® certification. Eligible appliances must have been purchased in the past 365 days. This 2009 rebate coupon expires 12/15/09.

♦♦♦Appliances must be installed ♦♦♦ Itemized complete receipts showing payment in full are required ♦♦♦ Incomplete/ineligible forms will be returned ♦♦♦ Current ENERGY STAR® certification required* Rebate Requirements: please check as applicable

4.

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I am currently a Clallam County PUD customer. 5. I’ve listed the PUD Appliance Code* or attached the energystar.gov listing page for each appliance. 6.

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2.

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3.

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The below appliances were new at the time of purchase and purchased within the past 365 days.

7.

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1.

Please circle one appliance per line: WM=Washer WM

DW

RF

FZ

WM

DW

RF

FZ

WM

DW

RF

FZ

Please Print

Brand Name

Please Print

Brand Name

Please Print

Brand Name

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I’ve attached full copies of itemized receipts showing payment in full for each appliance. The rebate appliances are now installed at the PUD service address listed below. I use an electric clothes dryer at the below service address. (Required for Washer Rebate) An electric H2O heater supplies the Washer &/or Dishwasher listed below. (Required for Rebate)

DW=Dishwasher

RF=Refrigerator

FZ=Freezer

Model #

PUD Appliance Code*

Date Installed

Model #

PUD Appliance Code*

Date Installed

Model #

PUD Appliance Code*

Date Installed

With my signature below, I certify that: 1) the information I’ve provided is accurate and complete; 2) I understand that Clallam County PUD (PUD) can only issue rebates for installed eligible appliances with current official* ENERGY STAR® certification; & 3) I will allow a PUD &/or Bonneville Power Administration Rep to verify installation of said appliance(s).

Please Print Name on Utility Account

Please Print

Name of Rebate Claimant Check if Same

Please Print Service Address Where Installed

Signature of Recipient

Please Print

Rebate Recipient’s Mailing Address

City

City

Zip Code

Phone #

State

PUD Account #

Zip Code

Return form with required attachments to your local PUD office -OR- PUD Rebates, POB 1090, Port Angeles, WA 98362 I hereby certify under penalty of perjury that to the best of my knowledge, the materials have been furnished, the services rendered or the labor performed as described herein, and that the claim is a just, due and unpaid obligation against PUD #1 of Clallam County, and I am authorized to authenticate & certify said claim.

Approved Date:

PUD Office Use Only Voucher No. Warrant No. Fund:

Expense Distribution: 908405.6481.1 Washer Rebate

$

908405.6481.2 Dishwasher Rebate $ 908405.6481.4 Refrigerator Rebate $ 908405.6481.6 Freezer Rebate

$

Total: $

*ENERGY STAR® Certification Verification Methods: Rebates can only be issued for appliances with current ENERGY STAR® certification demonstrated by listing(s) on the official ENERGY STAR® website (www.energystar.gov). The PUD offers the following ENERGY STAR® verification methods to help you ensure that your appliance(s) is/are eligible for the rebate: Please note: 1) New models for 2009/late 2008 may take a few months to appear on ENERGY STAR® appliance lists. 2) Asterisks

*on ENERGY STAR

®

lists are “wild cards”; they mean, “Insert any letter or number here.”

ENERGY STAR® Certification Verification: Without the Internet 1) Contact a participating* Clallam County Appliance vendor and request the PUD Appliance Code(s) for your appliance(s). Participating vendors have been instructed to provide our mutual customers with these codes. *Pacific Refrigeration, Sears, Home Depot, Costco, Designed for Living

2) Visit any PUD office to review their PUD Appliance Code(s) Binder. This binder -- updated at least six times per year -- will contain printouts of rebate eligible appliances from the official ENERGY STAR® website. a. Select the appliance category you’re seeking b. Review the list of appliances alphabetized by brand name. i. Note: Some GE Appliances may be listed under their model series, e.g., Profile, Café, etc. c. Find the PUD Appliance Code for the appliance; write it down on Side 1 of this form in the space provided next to the corresponding appliance.

ENERGY STAR® Certification Verification: Using the Internet 1) Visit the PUD’s ENERGY STAR® Appliance Rebate webpage at: www.clallampud.net/conservation a. Select the PUD Appliance Code link for the appliance category you’re seeking. b. Follow steps 2b and 2c above. 2) Visit the source of the above PUD Appliance Code listings: www.energystar.gov a. Under the Products heading, select Appliances. b. On the Appliances page, select the appliance category you’re seeking. 1. Under Resources (right margin of page at time of print), select: a) the interactive search link – or -- the Excel spreadsheet 2. Once you’ve found your appliance listing, print that page and attach it to your Rebate form.

Other Rebates & Incentives of Interest: $50 High Efficiency Water Heater* Rebate: Storage type of 50 gallons or more. 50–79 gallon H2O heaters must have an energy factor > 0.93. H2O heaters 80 gallons and above must have an energy factor > 0.91. $20 ENERGY STAR Compact Fluorescent Light Fixture Rebate: Note: rebate is for hard-wired fixtures. Tube type fixtures, e.g., T-8, T-12, etc. are ineligible.

$350 - $750 Duct Sealing Incentive** In a typical house, about 20% of the air in duct systems is lost through leaky, poorly connected ducts. Sealing and insulating ducts increase efficiency, lower your energy bills (up to 20%), and can often pay for itself in energy savings. •

®

$220 Shower Drainwater Heat Recovery Rebate: Typically 80–90% of the energy used to heat household water goes down the drain. Drain-water heat recovery systems capture this energy to preheat cold water entering the water heater or going to other water fixtures. $350 - $750 Duct Sealing Incentive** In a typical house, about 20% of the air in duct systems is lost through leaky, poorly connected ducts. A well sealed duct system may allow you to downsize to a smaller, less costly heating system. Note: No pre--approval needed for manufactured homes.

•

Jobs must meet Performance Tested Comfort System® (PTCS™) Duct Program specifications & testing procedures. No pre-approval needed for manufactured homes.

$300 - $2,400 High-efficiency Heat Pump Incentive** If you heat with electricity, a heat pump can reduce your heating electricity use by as much as 30%–40%. • Jobs must meet Performance Tested Comfort System® •

(PTCS™) Duct Program specifications & testing procedures. New construction homes are eligible for this program.

$6/sq. ft. Window Incentive** • • • • •

Original windows (includes French or sliding doors) must be double-paned & metal framed OR single-paned. Garden windows are excluded from this rebate. Windows must be in rooms with hardwired electrical heating. Replacement windows may not be larger than originals. Windows must have U-values of 0.30 or less.

Please note: restrictions apply to all Rebates & Incentives; be sure to observe all program requirements to ensure that you are eligible. Rebates and/or Incentives may be modified or discontinued at any time. **Requires job pre-approval by PUD prior to installation.