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AMU REBATE QUALIFICATIONS

REFRIGERATOR AND DISHWASHER

Qualifying Customers
AMU residential customers are eligible for rebates when buying a qualifying ENERGY STAR®-labeled model. The
program is applicable only for the purchase of qualifying new refrigerators and dishwashers to be used where the
electricity is supplied by AMU.

Rebate Details
Refrigerators and dishwashers must be ENERGY STAR® labeled units to qualifty for rebates. AMU will issue
rebate in the form of a credit on customers electric bill. ENERGY STAR® is a government/industry partnership that
makes it easy for you to save money and protect the environment. Watch for products with the ENERGY STAR®
logo to ensure the appliance is energy-efficient. Talk to your dealer to find out which brands and models are eligible
for AMU rebates. AMU is not responsible if your dealer provided inaccurate information about the amount and/or
conditions of the actual rebate.

Application Details
Customers must apply for rebates within one year of the purchase date shown on the sales receipt. Applications must
include complete retailer and applicable appliance information including:
• The volume (cubic feet)
• Make, model number, and serial number of the appliance
• The energy efficiency of the appliance including the Annual Energy Use Rating in Kwhr/year for a
refrigerator
• The Energy Factor (EF) for a dishwasher

Failure to complete this information will result in a rejection of the application. AMU reserves the right to conduct
random inspections to verify installation of the appliance at the address indicated on the front of this form. If AMU
inspects the appliance, the rebate application will not be processed until the inspection has been satisfactorily
completed. Inspections may be performed after the rebate payment at AMU’s discretion.

Rebate qualifications and amounts are subject to change at any time. AMU conservation rebate programs may be
cancelled or changed with 60 days notice. AMU customers should check with the local AMU office to determine
whether program changes have occurred. AMU will notify participating appliance dealers of pertinent program
changes.

If you have questions while filling out this form, please call 763-576-2903 weekdays between 7:00 a.m. and 3:30 p.m.
for assistance. You can also check the website at www.energystar.gov to see if the unit qualifies. Please allow four
to six weeks for credit on account.

SEND COMPLETE APPLICATIONS TO:

2015 First Avenue


Anoka, MN 55303
Refrigerator and Dishwasher Rebate Program (See previous page for qualifications)

IMPORTANT: Please include a copy of dated sales receipt/invoice including the


Manufacturer, Model Number, Serial Number, Volume (cubic feet) and Annual Energy Use
(Kwhr/year) or the Energy Factor (EF). Please complete ONE form per appliance. Only complete
applications will be processed. AMU account numbers must be included. Submit all requested
information, sales receipt/invoice, rebate form and required signature to receive your rebate within 4 to
6 weeks. Appliances must be installed where electric service is provided by AMU on a retail
basis. LIMIT ONE REBATE FOR EACH TYPE OF APPLIANCE PER CUSTOMER
ACCOUNT. Program standards are subject to change without prior notice. Rebate forms must be
submitted within 12 months of purchase date. If you have any questions about completing this form,
please call 763-576-2903.

Send complete rebate application to: AMU, 2015 First Avenue, Anoka, MN 55303

AMU CUSTOMER INFORMATION (Please print clearly)

Customer Name: Daytime Phone #:


Address: Evening Phone #:
City: State: Zip: Account #:
(see current AMU electric bill for account number)

Customer Type: Homeowner  Renter Landlord  Builder  Commercial Other ________________________

Customer Signature Date

EQUIPMENT INFORMATION

Manufacturer: Model #: Serial #:


Annual Energy Use Dishwasher Energy Factor
Cubic Feet: (Kwhr/year): (EF)

Is this a replacement appliance:  Yes  No


Refrigerator Rebate Amount $55.00 Dishwasher Rebate Amount $50.00

RETAILER INFORMATION
Retailer Name/Store: Phone #:
Address: City/State/Zip:

For statistical purposes only, please provide the following information. AMU will combine your response with others for analysis, as
required by the Minnesota Department of Public Service.
1. Find your household size on the table to your right. # of People in Annual Household
Household Income
2. Determine your annual household income, before taxing, including pension, 1 $17,456
social security, etc. 2 $22,828
3. Is your household income above or below the amount corresponding to your 3 $28,200
household size in this table? Above  Below 4 $33,572
NOTE: Random inspections of units will be conducted to verify installation at 5 $38,940
the address included above. In the event the unit is to be inspected, the rebate 6 $44,312
application will not be processed until the inspection has been satisfactorily
7 $45,320
completed. Inspections may be performed after rebate payment at the AMU’s
8 $46,328
discretion.

FOR OFFICE USE ONLY. DO NOT WRITE IN THIS AREA


Approved by: Date: Rebate Amt: $ Installed Date:
form2008

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