Home Appliance Rebates

Appliance Rebate Terms and Conditions

Member Information

Member Name

(as it appears on electric bill)

Electric Utility Account Number

(found on monthly bill)

Primary Phone

Enter your 10-digit phone number without the dashes.

Service Address

(where equipment is installed)

City

State Abbreviation

Zip Code

Is your mailing address different than you service address?

YesNo

Mailing Address

City

State Abbreviation

Zip Code

Instructions: Fill out the manufacturer name, model number, date of purchase, and quantity of each item you wish to receive a rebate for and upload any/all itemized receipts or invoices.

Products must be new and in working condition. Used or refurbished products are not eligible for incentives. ENERGY STAR products can be verified at energystar.gov/productfinder.

Clothes Washer

ENERGY STAR Qualified.
Limit 2.

Manufacturer:

Model #

Date Purchased

MM-DD-YYYY

Quantity

Incentive Amount

Total Incentive Amount

Total kWH Savings

Clothes Dryer: Standard Electric

ENERGY STAR Qualified.
Limit 2.

Manufacturer:

Model #

Date Purchased

MM-DD-YYYY

Quantity

Incentive Amount

Total Incentive Amount

Total kWH Savings

Clothes Dryer: Electric Heat Pump

ENERGY STAR qualified heat pump dryer.
May be vented or ventless.
Standard electric dryers do not qualify if they do not have a heat pump.
Limit 2.

Manufacturer:

Model #

Date Purchased

MM-DD-YYYY

Quantity

Incentive Amount

Total Incentive Amount

Total kWH Savings

Freezer

ENERGY STAR Qualified.
Limit 2.

Manufacturer:

Model #

Date Purchased

MM-DD-YYYY

Quantity

Incentive Amount

Total Incentive Amount

Total kWH Savings

Refrigerator

ENERGY STAR Qualified.
Compact fridge excluded.
Limit 2.

Manufacturer:

Model #

Date Purchased

MM-DD-YYYY

Quantity

Incentive Amount

Total Incentive Amount

Total kWH Savings

Room Air Purifier

ENERGY STAR Qualified.
Limit 4.

Manufacturer:

Model #

Date Purchased

MM-DD-YYYY

Quantity

Incentive Amount

Total Incentive Amount

Total kWH Savings

Portable Room Dehumidifier

ENERGY STAR Qualified.
Limit 4.

Manufacturer:

Model #

Date Purchased

MM-DD-YYYY

Quantity

Incentive Amount

Total Incentive Amount

Total kWH Savings

Advanced Power Strip: Wall Mounted

ENERGY STAR Qualified.
Limit 4.

Manufacturer

Model #

Date Purchased

MM-DD-YYYY

Quantity

Incentive Amount

Total Incentive Amount

Total kWH Savings

Room Air Conditioner

ENERGY STAR Qualified.
Limit 4 per install address.

Manufacturer:

Model #

Date Purchased

MM-DD-YYYY

Quantity

Incentive Amount

Total Incentive Amount

Total kWH Savings

Induction Range/Stove

Induction range, stove, or cook top with a minimum of 3 burners.
Portable induction cook tops and gas ranges or stove tops do not qualify.
Limit 2.

Manufacturer:

Model #

Date Purchased

MM-DD-YYYY

Quantity

Incentive Amount

Total Incentive Amount

Total kWH Savings

Receipts and Invoices Upload

Additional Receipts and Invoices Upload

Comments

Total Incentives for Appliances

All rebates $100 or less will be credited to the account.

Do you qualify as a low-income household?

YesNoUnsure/Prefer not to sayThis helps us ensure our programs reach members who may benefit most. Your response is confidential.

Income Qualified Services Eligibility

Persons in the family/household must be at or below 200% of the Federal Poverty Level

Family Size	Gross Annual Income
1	$31,300
2	$42,300
3	$53,300
4	$64,300
5	$75,300
6	$86,300
7	$97,300
8	$108,300

Terms and Conditions

I certify that this information is true and accurate. I understand that Cherryland Electric Cooperative reserves the right to inspect my items at any time and may charge me the full amount of this rebate, plus interest, should they find the information presented here to be false in any way.

Type your name to electronically sign this application