Rebate - Electric Water Heater

ELECTRIC WATER HEATER REBATE - $100 CHECK LIST ____Part A – Member information ____Part B – Dealer information ____Part C – Unit information ____Receipt of Purchase within 12 months of Rebate submission

I would prefer my rebate to be: ____Sent to me by direct check ____Credited to my FEC account

I ____________________________verify that the equipment listed below is installed at this location SIGN HERE Part A – Member Information:

Account Number: __________________________________________ Member Name: ____________________________________________ Mailing Address: ___________________________________________ Home Phone #: __________________ Work Phone #: ______________ Social Security Number: ______________________________________ How did you hear about FEC’s Rebate Program? ___________________________________________ Is this a newly built home?:

YES _____

NO _____

Part B – Dealer Information

Dealer Name: ____________________________________________ Address: ________________________________________________ Phone Number: __________________________________________

Part C – Unit Information Please note the EER Rating must be .92 or above to qualify for rebate. Model of new Unit: _____________________

EER Rating: ________________

Serial Number of new Unit: _______________________________________ Number of Gallons: ______________________________________________ Life of Warranty: ________________________________________________ This unit replaces a: _______electric

_______gas

_______propane

Mail with a copy of the receipt to: Rebates Farmers Electric Cooperative PO Box 6037 Greenville, TX 75403

_______other