6.1d1 EMRUSR 07-09-2024SATES
Clothes Dryer • Clothes Washer • Dehumidifier • r1
Dishwasher • New Refrigerator/Freezer • '
Recycled Refrigerator/Freezer • Air Purifier
Ceiling Fan • Ceiling Fan With LED Light
Tier II Power Strip • Smart Irrigation Controller
Installation • Toilet • Variable Speed Pool Pumps
See back for details regarding specific rebate requirements.
ERMU makes it easier to save energy and money on ENERGY STAR® -certified and WaterSense-labeled products with appliance
and home efficiency rebates. When you purchase rebate -qualifying products, you'll conserve natural resources by using less
energy and water. This not only helps to reduce long-term utility rates but also controls energy costs.
.................................................................................................................................................................. .
How to Receive a Rebate
(Valid for customers of Elk River Municipal Utilities only. Rebates come in the form of bill credit.)
1 Complete the front and back of this rebate form. 4 Mail or bring to 0�FE
2 Include a co of the original. itemized sales receipt Elk River Municipal Utilities
copyp SCAN HERE
and/or invoice for each product. ATTN Rebate Program to submit
13069 Orono Pkwy NW, Elk River, MN 55330
3 Include a copy of the energy guide label containing documents4
ENERGY STAR Symbol or denotation if applicable. OR Email customerserviceaa ermumn.com online.
CUSTOMER INFORMATION (please complete all information below)
Name Phone
Install Address City
Email Account #
RETAILER / CONTRACTOR / INSTALLER INFORMATION
Company Name Phone
Mailing Address City
County
State Zip
Email Address
State
HE
CERTIFICATIONS AND SIGNATURE
I hereby certify that
• The information contained in this application is accurate and complete.
• All installation is complete, and the unit(s) is operational prior to submitting application.
• All rules of this rebate program have been followed.
I agree to verification of equipment installation which may include a site inspection by a program or utility representative. I understand that I
am not allowed to receive more than one rebate from this program on any piece of equipment. I agree to indemnify, defend, hold harmless
and release ERMU from any claims, damages, liabilities, costs and expenses (including reasonable attorney's fees) arising from or relating
to the removal, disposal, installation or operation of any equipment or related materials in connection with the programs described in this
application, including any incidental, special or consequential damages.
ERMU reserves the right to reject any rebate application submitted as a result of work performed by a contractor who has failed to adhere
to the terms and conditions established for the rebate program.
Homeowner Signature Print Name Date
Elk River
Municipal Utilities
�atieTseso APPLIANCE AND HOME EFFICIENCY
m @ms A mr RESIDENTIAL REBATE APPLICATION
EPA cc
CLOTHES DRYER (Must be ENERGY STAR®certified) REBATE: $40 / UNIT
Quantity
Type (select one in each group) ❑ Gas ❑ Electric ❑ Compact ❑ Standard ❑ Vented ❑ Ventless
Manufacturer Name Model Number Date of Install
CLOTHES WASHER (Must be ENERGY STAR®certified)
Quantity Building Type (select one) ❑ Reverse Cycle
Type (select one) ❑ Front Load ❑ Top Load Capacity (cubic feet)
Drying Energy Source (select one) ❑ Gas ❑ Electric ❑ Unknown
Manufacturer Name Model Number Date of Install
REBATE: $40 / UNIT
❑ Louvered
DEHUMIDIFIER (Must be ENERGY STAR" certified AND UEF greater than 2) REBATE: $30 / UNIT
Quantity Capacity (pints / day) New Unit Energy Factor (UEF)
Manufacturer Name
D ISHWASH ER (Must be ENERGY STAR® certified)
Quantity
Manufacturer Name
REFRIGERATOR/FREEZER
(Must be ENERGY STAR® certified)
Quantity
Iur.reM101 Ri117-M
Type (select one) ❑ Compact
Model Number
Date of Install
REBATE: $40 / UNIT
❑ Standard
Date of Install
REBATE: $100 / UNIT (When buying new and $35 / UNIT
recycling an old unit in working order) (When buying new only)
Type (select one) ❑ Freezer ❑ Refrigerator ❑ Both
Style (select one) ❑ Compact Chest ❑ Compact Upright ❑ Standard Upright
Through the Door Ice (select one) ❑ Yes ❑ No Defrost Type (select one) ❑ Manual ❑ Auto ❑ Partial Auto
Configuration (select one) ❑ Refrigerator Only ❑ Top Mounted Freezer ❑ Side by Side ❑ Bottom Mounted Freezer
Manufacturer Name Model Number Date of Install
ADDITIONAL ITEMS THAT QUALIFY FOR REBATES (See below)
Select any applicable item(s) below. A representative may need to contact you for additional information.
❑ ENERGY STAR® Air Purifier - $35 ❑ ENERGY STAR® Ceiling Fan - $10 ❑ Tier II Power Strip - $20
❑ ENERGY STAR® Ceiling Fan with Integral LED Light - $20 ❑ Variable Speed Pool Pumps w/E.F. < 3.8 - $200
❑ WaterSense-labeled toilet with a rating of 1.28 gallons or fewer per flush - $25
❑ WaterSense- labeled smart irrigation controller and installation - Up to 50% of the device and installation costs. Not to exceed $250
Must be linked to local weather via internet, weatherstation, oran ET waterserver.
Manufacturer Name
Model Number
173
Date of Install