It Pays toSave

Appliance Rebate Form

PO Box A
Member Information Date: Spokane, WA 99219
Phone (509) 747-7151
Name: FAX (509) 747-7987

Address:

City: State: Zip:

Home Phone: Work Phone: Email:

Installation Address:

Inland Power Member Number:

Type of Rebate:
Energy Star Dishwasher - $25
1 - Manufacturer: Model#: Serial#:

Date of Purchase: Type of water heater: Electric Gas

Energy Star Refrigerator/Freezer - $25

2 - Manufacturer: Model#: Serial#:

Date of Purchase:

Energy Star Clothes Washer - $50

3 - Manufacturer: Model#: Serial#:

Date of Purchase: Type of water heater: Electric Gas

To qualify for the above rebates you must be a current member of Inland Power & Light. Please fill out this form
in its entirety and return to Inland Power with a copy of your receipt. Requests for rebates must be received
within 90 days of purchase. Please allow 2-4 weeks for processing. These programs are subject to change
without notice. Inland Power & Light reserves the right to inspect all installed measures prior to issuing a rebate.

I certify that I have satisfied all of Inland’s program requirements.

Member Signature: Date:

IPL USE ONLY

Application Date for Conservation Work

Completion Date for Conservation Work

Measure Qualifies as:

RTF Ref. Number kWh Savings BPA CREDIT GL# 908.46 DW - $25
RTF Ref. Number kWh Savings BPA CREDIT GL# 908.47 RF - $25
RTF Ref. Number kWh Savings BPA CREDIT GL# 908.48 CW - $50
Total

PAYMENT AUTHORIZED DATE AUTHORIZED