Shrewsbury Electric and SELCO

100 Maple Ave.

Cable Operations Shrewsbury, MA 01545

508-841-8500
EnergyStar Dehumidifier Rebate Form

Please fill out this form completely and mail to: SELCO EnergyStar
Dehumidifier Rebate:
SELCO
Attention: Rebate Offer Rebate will appear
100 Maple Avenue as $25 credit to your
Shrewsbury, MA 01545 SELCO electric bill.

Rebate forms may also be dropped off in person at the SELCO LIMIT ONE DEHUMIDIFIER
office during regular business hours (7:30 a.m. to 4:30 p.m. M-F) REBATE PER SELCO
ACCOUNT

All information below is REQUIRED to receive the Dehumidifier Rebate from SELCO ************************

SELCO Electric Account #: ____ ____ ____ ____ ____ ____ ____ ____ -- ____ ____ ____ How to get your
rebate:
Customer Name: _________________________________________________________________
1. Return the following
Utility Service Address (Do Not List P.O. Box): _____________________________________________ to SELCO:

City/State/Zip: Shrewsbury, MA 01545 . Phone: __________________________________ a. Completed Rebate

Form

EnergyStar Dehumidifier Product Information b. Copy of Dated Sales

Receipt – Please
Brand: _____________________________ Model #: ________________________________ Indicate Dehumidifier
by Highlighting or
Circling the line item
Serial # (Rebate Will Not Be Processed Without Serial #): ________________________________________
c. UPC Symbol Cut from
Store Purchase Information Dehumidifier Package

Name of Store Where Purchased: ___________________________________________________ 2. Allow 6-8 Weeks for

Processing
Store Address: __________________________________________________________________
************************

City/State/Zip: ___________________________________________________________________ Qualified EnergyStar-rated

Dehumidifiers must be
Purchase Price: ______________________ Purchase Date: ___________________________ purchased between 04/01/10
and 08/31/10 and
postmarked by 09/15/10.
Customer Agreement
SELCO reserves the right to
By signing this form, I certify that I purchased the EnergyStar dehumidifier listed above for deny applications based on
missing or fraudulent
installation at the utility service address noted above. I also certify that I am a customer of submissions.
Shrewsbury Electric and Cable Operations.

I understand that a rebate of $25.00 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
Dehumidifier
Customer Signature (Please Sign Here): __________________________________________________ UPC Symbol
HERE
This rebate offer is available to Shrewsbury Electric and Cable Operations electric customers ONLY. Eligible
dehumidifiers must be purchased between April 1, 2010 and August 31, 2010 and must be found on the
EnergyStar compliant list found on the EnergyStar website at http://www.energystar.gov/dehumidifier
No exceptions will be made.