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SATES <br />Clothes Dryer • Clothes Washer • Dehumidifier • r1 <br />Dishwasher • New Refrigerator/Freezer • ' <br />Recycled Refrigerator/Freezer • Air Purifier <br />Ceiling Fan • Ceiling Fan With LED Light <br />Tier II Power Strip • Smart Irrigation Controller <br />Installation • Toilet • Variable Speed Pool Pumps <br />See back for details regarding specific rebate requirements. <br />ERMU makes it easier to save energy and money on ENERGY STAR® -certified and WaterSense-labeled products with appliance <br />and home efficiency rebates. When you purchase rebate -qualifying products, you'll conserve natural resources by using less <br />energy and water. This not only helps to reduce long-term utility rates but also controls energy costs. <br />.................................................................................................................................................................. . <br />How to Receive a Rebate <br />(Valid for customers of Elk River Municipal Utilities only. Rebates come in the form of bill credit.) <br />1 Complete the front and back of this rebate form. 4 Mail or bring to 0�FE <br />2 Include a co of the original. itemized sales receipt Elk River Municipal Utilities <br />copyp SCAN HERE <br />and/or invoice for each product. ATTN Rebate Program to submit <br />13069 Orono Pkwy NW, Elk River, MN 55330 <br />3 Include a copy of the energy guide label containing documents4 <br />ENERGY STAR Symbol or denotation if applicable. OR Email customerserviceaa ermumn.com online. <br />CUSTOMER INFORMATION (please complete all information below) <br />Name Phone <br />Install Address City <br />Email Account # <br />RETAILER / CONTRACTOR / INSTALLER INFORMATION <br />Company Name Phone <br />Mailing Address City <br />County <br />State Zip <br />Email Address <br />State <br />HE <br />CERTIFICATIONS AND SIGNATURE <br />I hereby certify that <br />• The information contained in this application is accurate and complete. <br />• All installation is complete, and the unit(s) is operational prior to submitting application. <br />• All rules of this rebate program have been followed. <br />I agree to verification of equipment installation which may include a site inspection by a program or utility representative. I understand that I <br />am not allowed to receive more than one rebate from this program on any piece of equipment. I agree to indemnify, defend, hold harmless <br />and release ERMU from any claims, damages, liabilities, costs and expenses (including reasonable attorney's fees) arising from or relating <br />to the removal, disposal, installation or operation of any equipment or related materials in connection with the programs described in this <br />application, including any incidental, special or consequential damages. <br />ERMU reserves the right to reject any rebate application submitted as a result of work performed by a contractor who has failed to adhere <br />to the terms and conditions established for the rebate program. <br />Homeowner Signature Print Name Date <br />