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PRODUCTS THAT QUALIFY FOR REBATES (Rebates valid up to one year after date of installation) <br />Quantity Capacity (pints / day) <br />Manufacturer Name Model Number Date of Install <br />Quantity Building Type (select one) Single Family Multi Family <br />Type (select one) Front Load Top Load Capacity (cubic feet) <br />Drying Energy Source (select one) Gas Electric Unknown <br />Manufacturer Name Model Number Date of Install <br />Quantity Type (select one) Compact Standard <br />Manufacturer Name Model Number Date of Install <br />Select any applicable item(s) below. A representative may need to contact you for additional information. <br /> ENERGY STAR® Air Purifier - $35 ENERGY STAR® Ceiling Fan - $10 Tier II Power Strip - $20 <br /> ENERGY STAR® Ceiling Fan with Integral LED Light - $20 Variable Speed Pool Pumps w/E.F. < 3.8 - $200 <br /> WaterSense-labeled toilet with a rating of 1.28 gallons or fewer per flush - $25 <br /> WaterSense-labeled smart irrigation controller and installation - Up to 50% of the device and installation costs. Not to exceed $250 <br /> Must be linked to local weather via internet, weather station, or an ET water server. <br /> Manufacturer Name Model Number Date of Install <br />DEHUMIDIFIER (Must be ENERGY STAR® certified) REBATE: $30 / UNIT <br />CLOTHES WASHER (Must be ENERGY STAR® certified) REBATE: $40 / UNIT <br />DISHWASHER (Must be ENERGY STAR® certified) REBATE: $40 / UNIT <br />ADDITIONAL ITEMS THAT QUALIFY FOR REBATES (See below) <br />Quantity <br />Type (select one in each group) Gas Electric Compact Standard Vented Ventless <br />Manufacturer Name Model Number Date of Install <br />CLOTHES DRYER (Must be ENERGY STAR® certified) REBATE: $40 / UNIT <br />Quantity Type (select one) Freezer Refrigerator Both <br />Style (select one) Compact Chest Compact Upright Standard Upright <br />Through the Door Ice (select one) Yes No Defrost Type (select one) Manual Auto Partial Auto <br />Configuration (select one) Refrigerator Only Top Mounted Freezer Side by Side Bottom Mounted Freezer <br />Manufacturer Name Model Number Date of Install <br />REFRIGERATOR/FREEZER <br />(Must be ENERGY STAR® certified) <br />REBATE: $100 / UNIT (When buying new and <br />recycling an old unit in working order) <br />$35 / UNIT <br />(When buying new only) <br />APPLIANCE AND HOME EFFICIENCY <br />RESIDENTIAL REBATE APPLICATION <br />76