Rebate Applicance Package 2009
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ENERGY STAR® qualified Appliance Package
$50–$100 Rebate from Minnesota Power and participating utilities Residential customers can purchase and take delivery of two to three ENERGY STAR qualified appliances (clothes washer, dishwasher, and refrigerator) from Janaury 1–December 31, 2009. Valid for customers of Minnesota Power and participating utilities. See back for details. STEP 1 TO BE COMPLETED BY RETAILER OR PURCHASER (Required for processing) Store Name
Store Salesperson
Store Phone Number
City
State
ZIP
Appliance must be ENERGY STAR qualified to be eligible for rebate. You must purchase all three appliances (clothes washer, dishwasher, and refrigerator) in order to qualify for a $100 rebate. Receive a $75 rebate for the purchase of a clothes washer and a dishwasher or refrigerator. Receive a $50 rebate for the purchase of a dishwasher and a refrigerator.
Please complete the following information (Required for processing) Appliance Type
Brand
Model Number
Serial Number
Clothes Washer Dishwasher Refrigerator Please check one: TOTAL Cash-Back Rebate $100.00 (all 3 appliances) TOTAL Cash-Back Rebate $75.00 (clothes washer and dishwasher or refrigerator) TOTAL Cash-Back Rebate $50.00 (dishwasher and refrigerator) STEP 2 TO BE COMPLETED BY PURCHASER (Required for processing) Electric Utility Company (required)
Customer Name
Street Address
City
Phone Number
Email
State
Purchase Date This/these appliance(s) will be used in a: Farm Business Apartment/Condo bldg (4 or more units)
Single Family Home (1-3 units)
PARTICIPATING UTILITIES Your electric utility must be listed below in order to qualify for Cash-Back Rebates. Aitkin Public Utilities
Gilbert Public Utilities
Mountain Iron Public Utility
Brainerd Public Utilities
Grand Rapids Public Utility
Pierz Public Utility
Ely Public Utilities
Minnesota Power
Two Harbors Power and Light
Copy of sales receipt must be sent with completed form.
ZIP
ENERGY STAR® qualified Appliance Package
$50–$100 Rebate from Minnesota Power and participating utilities STEP 3 This offer available to residential customers of Minnesota Power and participating utilities only. Offer may be subject to change without prior notice. Offer may not be used in conjunction with any other utility offer. Mail this completed form and a copy of your sales receipt showing model number, and purchase date to: MN ENERGY STAR Appliance Package Rebate, c/o WECC, 431 Charmany Drive, Madison, WI 53719 Offer valid January 1–December 31, 2009. Request must be postmarked no later than January 15, 2010. Offer expires December 31, 2009. If you do not receive your Cash-Back Reward within eight weeks of mailing, please call the Minnesota ENERGY STAR Program toll-free at 888.509.3247 ext. 303, between 8 a.m. and 5 p.m. Central Standard Time, Monday through Friday. Not responsible for lost, late, or undelivered responses. Late submissions will not be accepted. Incomplete forms will not be processed. Fraudulent submissions could result in federal prosecution under U.S. Mail Fraud Statute (18 U.S. code, section 1241 and 1242). This form has no cash value. Please retain a copy of it for your records. Qualifying appliance(s) must be installed within the service area of a participating utility. Minnesota utilities do not warrant the performance of installed equipment expressly or implicitly. This offer is sponsored by Minnesota Power and participating utilities. Minnesota Power and participating utilities, in partnership with ENERGY STAR, offer consumers and businesses energy efficient solutions that save money and help the environment. If you have questions on this form or the Minnesota ENERGY STAR Program, call 800.677.8423 or visit us online at www.mnpower.com/energystar. Confidentiality Statement: I am providing the requested information solely to be eligible to participate in this program and request that the personal information supplied by me be treated as confidential. Sign or Initial here_____________________________________________________
STEP 4 1. When did you become aware of the ENERGY STAR symbol? before purchase during purchase after purchase 2. How did you hear about the ENERGY STAR symbol? newspaper ad radio ad website utility bill insert news article in-store friend or relative other _______________ 3. Why did you purchase an ENERGY STAR qualified appliance? features better for environment energy savings money savings Cash-Back Rebate certified by independent entity 4. When did you become aware of the Cash-Back Rebate? before purchase during purchase after purchase 5. How did you hear about the Cash-Back Rebate? newspaper ad radio ad website utility representative news article in-store friend or relative other _______________
7. Is your home: newly constructed newly purchased 8. Your annual household income? less than $20,000 $75-99,999
existing (before 2000) other $20-49,999 above $100,000
$50-$74,999
9. Your occupation? ________________________________________________________________ 10. What type of water heater do you have? gas electric solar LP
oil
11. Are you replacing an existing appliance? yes no 12. Do you own any other ENERGY STAR qualified products? (check all that apply) light bulbs torchieres light fixtures electronics refrigerator dishwasher room a/c dehumidifier
6. The number of people living in your home, per age category: ___ under 17 years ___ 18-65 yrs. ___ over 65
Copy of sales receipt must be sent with completed form.
$50–$100 Rebate from Minnesota Power and participating utilities Residential customers can purchase and take delivery of two to three ENERGY STAR qualified appliances (clothes washer, dishwasher, and refrigerator) from Janaury 1–December 31, 2009. Valid for customers of Minnesota Power and participating utilities. See back for details. STEP 1 TO BE COMPLETED BY RETAILER OR PURCHASER (Required for processing) Store Name
Store Salesperson
Store Phone Number
City
State
ZIP
Appliance must be ENERGY STAR qualified to be eligible for rebate. You must purchase all three appliances (clothes washer, dishwasher, and refrigerator) in order to qualify for a $100 rebate. Receive a $75 rebate for the purchase of a clothes washer and a dishwasher or refrigerator. Receive a $50 rebate for the purchase of a dishwasher and a refrigerator.
Please complete the following information (Required for processing) Appliance Type
Brand
Model Number
Serial Number
Clothes Washer Dishwasher Refrigerator Please check one: TOTAL Cash-Back Rebate $100.00 (all 3 appliances) TOTAL Cash-Back Rebate $75.00 (clothes washer and dishwasher or refrigerator) TOTAL Cash-Back Rebate $50.00 (dishwasher and refrigerator) STEP 2 TO BE COMPLETED BY PURCHASER (Required for processing) Electric Utility Company (required)
Customer Name
Street Address
City
Phone Number
State
Purchase Date This/these appliance(s) will be used in a: Farm Business Apartment/Condo bldg (4 or more units)
Single Family Home (1-3 units)
PARTICIPATING UTILITIES Your electric utility must be listed below in order to qualify for Cash-Back Rebates. Aitkin Public Utilities
Gilbert Public Utilities
Mountain Iron Public Utility
Brainerd Public Utilities
Grand Rapids Public Utility
Pierz Public Utility
Ely Public Utilities
Minnesota Power
Two Harbors Power and Light
Copy of sales receipt must be sent with completed form.
ZIP
ENERGY STAR® qualified Appliance Package
$50–$100 Rebate from Minnesota Power and participating utilities STEP 3 This offer available to residential customers of Minnesota Power and participating utilities only. Offer may be subject to change without prior notice. Offer may not be used in conjunction with any other utility offer. Mail this completed form and a copy of your sales receipt showing model number, and purchase date to: MN ENERGY STAR Appliance Package Rebate, c/o WECC, 431 Charmany Drive, Madison, WI 53719 Offer valid January 1–December 31, 2009. Request must be postmarked no later than January 15, 2010. Offer expires December 31, 2009. If you do not receive your Cash-Back Reward within eight weeks of mailing, please call the Minnesota ENERGY STAR Program toll-free at 888.509.3247 ext. 303, between 8 a.m. and 5 p.m. Central Standard Time, Monday through Friday. Not responsible for lost, late, or undelivered responses. Late submissions will not be accepted. Incomplete forms will not be processed. Fraudulent submissions could result in federal prosecution under U.S. Mail Fraud Statute (18 U.S. code, section 1241 and 1242). This form has no cash value. Please retain a copy of it for your records. Qualifying appliance(s) must be installed within the service area of a participating utility. Minnesota utilities do not warrant the performance of installed equipment expressly or implicitly. This offer is sponsored by Minnesota Power and participating utilities. Minnesota Power and participating utilities, in partnership with ENERGY STAR, offer consumers and businesses energy efficient solutions that save money and help the environment. If you have questions on this form or the Minnesota ENERGY STAR Program, call 800.677.8423 or visit us online at www.mnpower.com/energystar. Confidentiality Statement: I am providing the requested information solely to be eligible to participate in this program and request that the personal information supplied by me be treated as confidential. Sign or Initial here_____________________________________________________
STEP 4 1. When did you become aware of the ENERGY STAR symbol? before purchase during purchase after purchase 2. How did you hear about the ENERGY STAR symbol? newspaper ad radio ad website utility bill insert news article in-store friend or relative other _______________ 3. Why did you purchase an ENERGY STAR qualified appliance? features better for environment energy savings money savings Cash-Back Rebate certified by independent entity 4. When did you become aware of the Cash-Back Rebate? before purchase during purchase after purchase 5. How did you hear about the Cash-Back Rebate? newspaper ad radio ad website utility representative news article in-store friend or relative other _______________
7. Is your home: newly constructed newly purchased 8. Your annual household income? less than $20,000 $75-99,999
existing (before 2000) other $20-49,999 above $100,000
$50-$74,999
9. Your occupation? ________________________________________________________________ 10. What type of water heater do you have? gas electric solar LP
oil
11. Are you replacing an existing appliance? yes no 12. Do you own any other ENERGY STAR qualified products? (check all that apply) light bulbs torchieres light fixtures electronics refrigerator dishwasher room a/c dehumidifier
6. The number of people living in your home, per age category: ___ under 17 years ___ 18-65 yrs. ___ over 65
Copy of sales receipt must be sent with completed form.
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