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Name Phone County <br />Install Address City State Zip <br />Email Account # <br />Company Name Phone Email Address <br />Mailing Address City State Zip <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 />RETAILER / CONTRACTOR / INSTALLER INFORMATION <br />CUSTOMER INFORMATION (please complete all information below) <br />CERTIFICATIONS AND SIGNATURE <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 />Clothes Dryer • Clothes Washer • Dehumidifier • <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 />Complete the front and back of this rebate form. <br />Include a copy of the original itemized sales receipt <br />and/or invoice for each product. <br />Include a copy of the energy guide label containing <br />ENERGY STAR® Symbol or denotation if applicable. <br />Mail or bring to <br />Elk River Municipal Utilities <br />ATTN Rebate Program <br />13069 Orono Pkwy NW, Elk River, MN 55330 <br />Email customerservice@ermumn.com <br />How to Receive a Rebate <br />(Valid for customers of Elk River Municipal Utilities only. Rebates come in the form of a bill credit.) <br />1 <br />2 <br /> 3 <br />4 <br /> <br />OR <br />OR <br />SCAN HERE <br />to submit <br />documents <br />online. <br />APPLIANCE AND HOME EFFICIENCY <br />RESIDENTIAL REBATES <br />ERMUMN.COM | 763.441.2020 | 13069 ORONO PARKWAY | PO BOX 430 | ELK RIVER, MN 55330-043075