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• LED Lighting <br />• Outdoor LED Fixtures <br />• LED Holiday Lighting <br />• Custom Lighting <br />013127131 M. . • Lighting Controls <br />See back for details regarding specific rebate requirements. <br />With ERMU's energy -efficient lighting rebates we make it easier to save energy and money on ENERGY STARO certified LED <br />products and lighting controls. Lighting rebates provide customers a cost-effective solution to reduce their electricity bills and <br />environmental impact by upgrading to energy -efficient lighting. <br />How to Receive a Rebate <br />(Valid for customers of Elk River Municipal Utilities only. Rebates come in the form of bill credit.) ry <br />1 Complete the front and back of this rebate form. 4 Mail or bring to OR L <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 ualif in product ATTN Rebate Program <br />q y g p 13069 Orono Pkwy NW, Elk River, MN 55330 to submit <br />3 A copy of energy guide label containing ENERGY STAR' documents Ll <br />Symbol or denotation if applicable. OR Email customerserviceaaermumn.com online. I. <br />CUSTOMER INFORMATION (please complete all information below) <br />Name <br />Install Address City State <br />Email Account # <br />Building Type (select one) ❑ Single Family ❑ Multi Family <br />RETAILER / CONTRACTOR / INSTALLER INFORMATION <br />Company Name Phone <br />Mailing Address City State <br />County <br />Email Address <br />Zip <br />Zip <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 />