6.01d2 EMRUSR 11-12-2024• LED Lighting
• Outdoor LED Fixtures
• LED Holiday Lighting
• Custom Lighting
013127131 M. . • Lighting Controls
See back for details regarding specific rebate requirements.
With ERMU's energy -efficient lighting rebates we make it easier to save energy and money on ENERGY STARO certified LED
products and lighting controls. Lighting rebates provide customers a cost-effective solution to reduce their electricity bills and
environmental impact by upgrading to energy -efficient lighting.
How to Receive a Rebate
(Valid for customers of Elk River Municipal Utilities only. Rebates come in the form of bill credit.) ry
1 Complete the front and back of this rebate form. 4 Mail or bring to OR L
2 Include a co of the original. itemized sales receipt Elk River Municipal Utilities
copyp SCAN HERE
and/or invoice for each ualif in product ATTN Rebate Program
q y g p 13069 Orono Pkwy NW, Elk River, MN 55330 to submit
3 A copy of energy guide label containing ENERGY STAR' documents Ll
Symbol or denotation if applicable. OR Email customerserviceaaermumn.com online. I.
CUSTOMER INFORMATION (please complete all information below)
Name
Install Address City State
Email Account #
Building Type (select one) ❑ Single Family ❑ Multi Family
RETAILER / CONTRACTOR / INSTALLER INFORMATION
Company Name Phone
Mailing Address City State
County
Email Address
Zip
Zip
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 0
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Municipal Utilities
ENERGY -EFFICIENT LIGHTING
RESIDENTIAL REBATE APPLICATION
LED LIGHTING (Screw -in bulbs only) REBATE: $2 / BULB
(Must be ENERGY STAR®certified, LED lights. For other types of lights, (Not to exceed 50% of cost)
fill out Outdoor Fixtures, Holiday Lighting, or Customer Lighting below as applicable)
Quantity Lumens New Lighting Watts
Space Type (select one) ❑ Interior Living Quarters ❑ Multi Family Common Area ❑ Exterior/Unconditioned Space
HVAC (select one) ❑ Heating Only ❑ Heating and Cooling ❑ Exterior/Unconditioned
Date of Installation
OUTDOOR LED FIXTURES
(Must be ENERGY STAR®certified, LED lights)
Quantity
LED HOLIDAY LIGHTING
(Must be ENERGY STAR®certified, LED lights)
Quantity of String Lights
LED Lighting Type (select one) ❑ LED Mini Holiday Lights
Date of Installation
Date of Install
REBATE: Up to $15 / FIXTURE
(Not to exceed 50% of fixture cost)
REBATE: $10 / STRING
(Not to exceed 50% of cost of string)
_ Quantity of Lights per String
❑ LED C7 Holiday Lights ❑ LED C9 Holiday Lights
CUSTOM LIGHTING REBATE: $0.20/ WATT REDUCED
(Must be ENERGY STAR®certified, LED lights) (Not to exceed 50% of lamp/fixture cost)
Quantity Previous Lighting Watts New Lighting Watts
Space Type (select one) ❑ Interior Living Quarters ❑ Multi Family Common Area ❑ Exterior/Unconditioned Space
HVAC (select one) ❑ Heating Only ❑ Heating and Cooling ❑ Exterior/Unconditioned
Date of Installation
LIGHTING CONTROLS
(Must be ENERGY STAR" certified, LED lights)
REBATE: $15 / CONTROL
(Not to exceed 50% of cost of control)
Total Connect Lighting Load (kW. If in watts, divide watts by 1,000 to get kW)
Space Type (select one) ❑ Interior Living Quarters ❑ Multi Family Common Area ❑ Exterior/Unconditioned Space
HVAC (select one) ❑ Heating Only ❑ Heating and Cooling ❑ Exterior/Unconditioned
Date of Installation
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