March Appliance Rebate Form
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Appliance Rebate Form Name and Address for Rebate
Mailing Address
(installation address)
(if different from installation address)
Name: Address:
Name: Address:
Account # Phone:
What type of water heater do you have? What type of dryer do you have?
Electric Electric
Gas Gas
** Energy Star Appliances ** Homeowner must supply copy of invoice that provides model number to verify installation and specifications of appliance. Water heater rebates also require warranty documentation.
Appliance Type Clothes Washer MEF>1.72
Brand Name
Model Number
Rebate Amount $70.00
(homes with electric water heater)
Clothes Washer MEF>1.72
$25.00
(homes with gas water heater)
Dishwasher Electric Water Heater Refrigerator Freezer (7.75 cu. ft. min)
$25.00 * $50.00 $50.00
* Water heater rebate amounts are listed on reverse side
I certify that this appliance was purchased for installation at the above address. I will allow a representative for Forest Grove Light & Power to verify the installation of the appliance. I understand that rebates are subject to availability of funds and may change without notice.
Signed: ___________________________________________
Date: ________________________
City of Forest Grove Light & Power Or drop Light & Power Office P.O. Box 326 off at: 1818 B Street, Forest Grove Forest Grove, OR 97116 Questions? (503) 992-3250 _____________________________________________________________________________________________________ Send form and invoice to:
FOR INTERNAL USE ONLY: Vendor No.: Budget No.: 610-41-30-520554 / GL927 Ref. No.: INCENTIVES VALID THROUGH 9/30/2009
03/17/2009
Electric Water Heater Rebates Warranty Less Than 20 Years Capacity (gallons) 50 to 64 65 to 79 80 to 118 119 & up
Energy Factor .93 .91 .91 .85
Rebate Amount $25 $40 $45 $40
20 Year Warranty Capacity (gallons) 50 to 64 65 & up 75 to 79 80 to 104 105 & up
Energy Factor .94 .94 .92 .92 .92
Rebate Amount $50 $75 $65 $75 $100
NOTE: Warranty documentation required for water heater rebate.
INCENTIVES VALID THROUGH 9/30/2009
03/17/2009
Mailing Address
(installation address)
(if different from installation address)
Name: Address:
Name: Address:
Account # Phone:
What type of water heater do you have? What type of dryer do you have?
Electric Electric
Gas Gas
** Energy Star Appliances ** Homeowner must supply copy of invoice that provides model number to verify installation and specifications of appliance. Water heater rebates also require warranty documentation.
Appliance Type Clothes Washer MEF>1.72
Brand Name
Model Number
Rebate Amount $70.00
(homes with electric water heater)
Clothes Washer MEF>1.72
$25.00
(homes with gas water heater)
Dishwasher Electric Water Heater Refrigerator Freezer (7.75 cu. ft. min)
$25.00 * $50.00 $50.00
* Water heater rebate amounts are listed on reverse side
I certify that this appliance was purchased for installation at the above address. I will allow a representative for Forest Grove Light & Power to verify the installation of the appliance. I understand that rebates are subject to availability of funds and may change without notice.
Signed: ___________________________________________
Date: ________________________
City of Forest Grove Light & Power Or drop Light & Power Office P.O. Box 326 off at: 1818 B Street, Forest Grove Forest Grove, OR 97116 Questions? (503) 992-3250 _____________________________________________________________________________________________________ Send form and invoice to:
FOR INTERNAL USE ONLY: Vendor No.: Budget No.: 610-41-30-520554 / GL927 Ref. No.: INCENTIVES VALID THROUGH 9/30/2009
03/17/2009
Electric Water Heater Rebates Warranty Less Than 20 Years Capacity (gallons) 50 to 64 65 to 79 80 to 118 119 & up
Energy Factor .93 .91 .91 .85
Rebate Amount $25 $40 $45 $40
20 Year Warranty Capacity (gallons) 50 to 64 65 & up 75 to 79 80 to 104 105 & up
Energy Factor .94 .94 .92 .92 .92
Rebate Amount $50 $75 $65 $75 $100
NOTE: Warranty documentation required for water heater rebate.
INCENTIVES VALID THROUGH 9/30/2009
03/17/2009
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