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WATER CONSERVATION <br />REBATE APPLICATION <br /> CUSTOMER INFORMATION <br />Name Account # <br />Address <br />City State Zip <br />Phone Email <br />APPLIANCE INFORMATION <br />Appliance Type Brand Model # <br />Appliance Purchased: <br />® <br />5.5 or less to qualify for $40 <br />® <br />$40 <br />$10 <br />1.28$25 <br />50%, not to <br /> exceed $250, <br /> to local weather via internet or phone connection. <br />Date of Purchase Copy of Receipt or Sales Invoice Attached <br /> IMPORTANT <br />763.441.2020 <br />31. <br />ERMUMN.COM | 763.441.2020 | 13069 ORONO PARKWAY | PO BOX 430 | ELK RIVER, MN 55330-0430 <br />200 <br />