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Name — <br />Address <br />City <br />Phone _ <br />Appliance Type <br />State <br />Email <br />Brand <br />Appliance Purchased (please fill out one form for each item): <br />Account # <br />Zip <br />Model # <br />❑ Clothes Washer - Must be ENERGY STAR® certified and have a water factor of 5.5 or less to qualify for $40 rebate. <br />❑ Dishwasher - Must be ENERGY STAR® certified to qualify for $40 rebate. <br />❑ Faucet - Must be WaterSense labeled to qualify for $10 rebate. <br />Toilet - Must be WaterSense labeled and have a rating of 1.28 gallons per flush or less to qualify for $25 rebate. <br />Smart Irrigation Controller - Must be WaterSense labeled to qualify for a rebate of up to 50%, not to <br />exceed $250, for the purchase and installation of a smart irrigation controller. The controller must be linked <br />to local Weather via internet or phone connection. <br />Date of Purchase <br />❑ Copy of Receipt or Sales Invoice Attached <br />• Contact our office at 763.441.2020 prior to purchase to ensure funds are still available. <br />• Purchase qualifying fixtures or appliances. <br />• Complete Water Conservation Rebate Application by December 31. <br />• Submit rebate application to ERMU, including itemized cash register receipt or sales invoice indicating <br />the brand and model purchased. Application and receipts can be submitted via mail or electronically <br />on our website at www.ERMUMN.com. <br />• Applicant must have ERMU water service to qualify for the rebate. *EPA <br />All rebates will be given in the form of a credit on your water utility bill. <br />