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Programmable Set-Back SELCO

100 Maple Ave.

Thermostat Rebate Form Shrewsbury, MA 01545

508-841-8500
Shrewsbury Electric and Cable Operations

Please fill out this form completely and mail to: SELCO Set-Back
Thermostat Rebate:
SELCO
Attention: Rebate Offer Rebate will appear as
100 Maple Ave. a credit to your
Shrewsbury, MA 01545 SELCO electric bill,
equal to 50% of
Rebate forms may also be dropped off in person at the SELCO thermostat purchase
office during regular business hours (7:30 a.m. to 5 p.m. M-F) price (up to $30).

LIMIT ONE THERMOSTAT


All information below is REQUIRED to receive the Set-Back Thermostat Rebate from SELCO REBATE PER SELCO
ACCOUNT
SELCO Electric Account #: ____ ____ ____ ____ ____ ____ ____ ____ -- ____ ____ ____ ************************

Customer Name: _________________________________________________________________ How to get your


rebate:
Utility Service Address (Do Not List P.O. Box): _____________________________________________
1. Return the following
City/State/Zip: Shrewsbury, MA 01545 . Phone: __________________________________ to SELCO:

Email (For SELCO to Notify Customer of Credit): ______________________________________________ a. Completed Rebate


Form

EnergyStar Set-Back Thermostat Product Information b. Attach Copy of Dated


Sales Receipt – Please
Brand: _____________________________ Model #: ________________________________ Indicate Thermostat by
Highlighting or Circling

Store Purchase Information c. UPC Symbol Cut from


Thermostat Packaging
Name of Store Where Purchased: ___________________________________________________
2. Allow 6-8 Weeks for
Store Location: __________________________________________________________________ Processing Credit

Purchase Price: ______________________ Purchase Date: ___________________________ ************************

Qualified EnergyStar-rated
Customer Agreement programmable set-back
Thermostats must be
By signing this form, I certify that I purchased the programmable set-back thermostat listed above purchased between 10/01/08
and 02/28/09 and postmarked
for installation at the utility service address noted above. I also certify that I am a customer of by 03/20/09.
Shrewsbury Electric and Cable Operations.

I understand that a rebate of 50% of the value of the set-back thermostat listed above (up to $30)
will appear in the form of a credit to my electric bill within two billing periods following receipt and
confirmation by SELCO of this completed form and the required accompanying information. Attach
Thermostat
Customer Signature (Please Sign Here): __________________________________________________ UPC Symbol
HERE
Suggested EnergyStar Thermostats can be found online at:
www.energystar.gov/ia/products/prod_lists/thermostats_prod_list.pdf

This rebate offer is available to Shrewsbury Electric and Cable Operations electric customers ONLY. Eligible thermostats
must be purchased between October 1, 2008 and February 28, 2009.

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