Residential Energy Efficiency Program

Appliance Rebate Application

Offer valid through September 30, 2009 or until funding expires

APPLICATION INSTRUCTIONS
1. Complete Application
2. Attach copy of your receipt detailing necessary information
3. Return to Benton PUD within 30 days of purchase
4. Remit completed form to: Benton PUD, 2721 W. 10th Ave., P.O. Box 6270,
Kennewick, WA 99336; (509) 582-1234
Applicant Name (please print) Phone Number Benton PUD Account #

Installation Unit/Apt. City Zip

Mailing Address Unit/Apt. City Zip

FOR BENTON
DESCRIPTION PUD USE ONLY
PTR#
CLOTHES WASHER* ENERGY STAR® QTY Brand Model # Date of $70 - RAP00271
Please check only one box $25 - RAP00284
Purchase
$70 Rebate – Heat provided by
electric water heater (MEF of >1.8)
$25 Rebate – Heat provided by gas
water heater (MEF of >1.8)
DISHWASHER* ENERGY STAR® QTY Brand Model # Date of EF68 - RAP00192
EF76 – RAP00195
$25 Rebate Purchase
EF85 – RAP00198
*All qualified ENERGY STAR dishwashers
apply
REFRIGERATOR* ENERGY STAR® QTY Brand Model # Date of RAP00011
$25 Rebate Purchase
*All qualified ENERGY STAR refrigerators apply

WATER HEATER* QTY Brand Model # Date of RWH00019

$25 Rebate Purchase
*Water heaters must be electric
*50 – 80 gallon & Energy Factor ratings as
follows: 50 gal =.93, 65 gal =.91, 80 gal =.91

By signing below, I certify that all information listed above is true and correct and the installation address is in
the Benton PUD service territory. I attest that I have not previously applied for or received a rebate for the
appliance listed above. I understand that Benton PUD reserves the right to verify installation of the listed home
appliance and that completion of this form does not guarantee my rebate. I acknowledge that Benton PUD’s
Appliance Rebate Program is subject to change and funding availability.

Applicant Signature__________________________________ Date___________________________

*All rebates are subject to change

FOR BENTON PUD USE ONLY
Premise/Invoice Number Energy Services Vendor ID Verified By/Date

Approved? GL DEP Resource Total Amount Manager Approval / Date

Yes No 908.31 45 117

6/2/2009