New ENERGY STAR Appliance Rebate Form

Applicant Information

Enter your Account #

First Name

Last Name

Email

Phone

Record Type Name

Service Address Information

Street

City

State Abbreviation

Please select... AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Zip Code

ENERGY STAR Equipment Info

Manufacturer

Model Number

Appliance Type

Please select... Air purifier All-in-one washer/dryer combo Clothes Dryer Clothes Washer Dehumidifier Dishwasher Freezer (must be 10 cubic feet) Inductive range (cooktop must be inductive) Refrigerator (must be 10 cubic feet) Room air conditionerYou may select more than one. Click and hold or use ctrl on your keyboard to select multiple.

Appliance Types

AppType

Attach Invoice Here

Terms and Conditions

• New appliance must be on cooperative lines. 

• New appliance must be electric.
• Incentive not to exceed the appliance cost. 
• Incentives are in place until December 31. Funds are limited.
• Required documentation must be submitted within 3 months of purchase. 
• Additional eligibility criteria may apply. Program is subject to change or cancellation without notice. Contact cooperative for details.  

Accept Terms and Conditions