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Plumas-Sierra Rural Electric Cooperative

2013 Energy Efficiency Appliance and Lighting Rebate Program

MEMBER INFORMATION
Name on PSREC Bill: Mailing Address: Service Address: Phone #: Account #: Meter #:

Please check appropriate boxes:  Single-family home  Multi-family apartment  Manufactured home

QUALIFYING ENERGY STAR® PRODUCT
Type of New ® ENERGY STAR Appliance Refrigerator - $125
Proof of Disposal must be included

Brand Name

Model Number

Purchase Date

Install Date

Freezer - $75
Proof of Disposal must be included

Washing Machine - $35
Proof of Disposal must be included

Dishwasher - $35
Proof of Disposal must be included

LED or LCD TV - $20
Proof of ENERGY STAR must be included

ENERGY STAR LED Lighting LED - $5/ea. Max 15
Proof of ENERGY STAR must be included

Brand Name

Wattage

# of Standard Bulbs Replaced

Install Date

What is your reason for replacing your appliance or product (Check one): Retirement of Secondary Refrigerator/Freezer Refrigerator or Freezer - $50
Include Proof of Disposal – No Replacement

Early Replacement for Efficiency or Year Purchased

Product Failed Serial #

Brand Name

Model Number

Terms and Conditions: 1. 2. 3. 4. 5. 6. 7. 8. 9. To be eligible for a rebate I certify I am a member of Plumas-Sierra Rural Electric Cooperative and receive electric service at the service address listed on the application. I understand I may not apply for the same rebate within a five year period. The product is permanently installed at the service address listed above and within PSREC service territory. Rebate eligibility is only available for measures installed January 1, 2013 to December 31, 2013 or while funding is available. All rebates will be issued on a first-come, first-serve basis. The rebate amount shall not exceed the purchase price. I understand only complete applications will be processed. All products installed are in accordance with applicable federal, state, and local laws, building codes, manufacturer’s specifications, and permitting requirements, and where applicable, used a licensed contractor. PSREC may not be held liable for or associated with equipment selection, installation, operation, safety or efficiency performance of the equipment purchased and installed under this program. I understand all rebates are subject to inspection, verification and disposal of old appliance. Date: For Official Use Only Date Received Date Approved Rebate Amount $ Confirmation Mailed

Member Signature: How did you hear about PSREC’s Rebate Program? Internet: ☐ Ruralite:☐ Bill Insert: ☐ Office: ☐ Other:

must provide copy of disposal receipt 5. proof of ENERGY STAR  LED rebate is limited to 15. business address and phone number  Itemized description of each product. proof of haul away or disposal of old appliance must be included  For LED or LCD Television. make and model number(s)  Purchase price per product  Purchase Date 3. When shopping for appliances.gov for more information.Plumas-Sierra Rural Electric Cooperative 2013 Energy Efficiency Appliance and Lighting Rebate Program PSREC offers programs to help you save money by making your home or business more energy efficient.  Retirement of secondary Refrigerator or Freezer (for disposal only. Complete Rebate Application  Read terms and conditions  Verify your product meets eligibility requirements  Include required attachments  Sign the application  Make copies for your records 2. and model # or retail product #). often denoted on the yellow Energy Guide label on appliances and TVs. Energy Efficiency Appliance and Lighting Rebates ENERGY STAR Refrigerator ENERGY STAR Freezer ENERGY STAR Washing Machine ENERGY STAR Dishwasher ENERGY STAR LED or LCD Television ENERGY STAR Light Emitting Diode (LED) Bulbs Retire a Secondary Refrigerator or Freezer without replacement APPLICATION INSTRUCTIONS 1. Mail completed application or apply online at www. such as a copy of the yellow EnergyGuide label with the ENERGY STAR on it  For NEW ENERGY STAR Refrigerator. Visit www. CA 96122 Questions? (530) 832-4261 or (800) 555-2207 Credit $125 $75 $35 $35 $20 $5 $50 For more information visit www. Make sure to obtain proof of ENERGY STAR compliance. purchase ENERGY STAR labeled models. Additional documentation required for the following products:  ENERGY STAR Product  Proof of ENERGY STAR certification.coop .coop  Verify all required attachments are enclosed  Don’t forget to sign your application 6. Allow approximately four weeks for rebate processing. For a product to carry the ENERGY STAR symbol. and credit may not be more than the purchase price (receipt required that shows quantity purchased. Freezer. lamp wattage.psrec.energystar. no replacement or give-away). Dishwasher and Washer rebates.psrec. Plumas-Sierra REC Attn: Rebates 73233 State Route 70 Portola. including manufacturer. it must meet or exceed federal energy efficiency and quality guidelines. Proof of Purchase must be included and must contain:  Retailer or Contractor name.