Tillamook People’s Utility District Tillamook People’s Utility District

$70 Energy Star Clothes Washer Rebate $70 Energy Star Clothes Washer Rebate
REBATE WILL BE APPLIED TO YOUR PUD ACCOUNT REBATE WILL BE APPLIED TO YOUR PUD ACCOUNT

Date_____________________ Account No. _____________________ Date_____________________ Account No. _____________________

Name______________________________________________________ Name______________________________________________________
Mailing Address_____________________________________________ Mailing Address_____________________________________________
___________________________________________________________ ___________________________________________________________
City State Zip City State Zip

Street Address: Street Address:

Manufacturer: Manufacturer:
Model Number: Model Number:

I certify this appliance was purchased for installation at the above service I certify this appliance was purchased for installation at the above service
address in the Tillamook PUD service area. I will allow a Tillamook PUD address in the Tillamook PUD service area. I will allow a Tillamook PUD
representative to verify its installation. representative to verify its installation.

Is your Water Heater electrically heated? □ Yes □ No Is your Water Heater electrically heated? □ Yes □ No
Is your Clothes Dryer electrically heated? □ Yes □ No Is your Clothes Dryer electrically heated? □ Yes □ No

Buyer’s Signature Date Buyer’s Signature Date

REBATE MUST INCLUDE COPY OF SALES RECEIPT AND REBATE MUST INCLUDE COPY OF SALES RECEIPT AND
BE SUBMITTED WITHIN SIX MONTHS OF PURCHASE BE SUBMITTED WITHIN SIX MONTHS OF PURCHASE

Rebate program is a limited time offer based on availability Rebate program is a limited time offer based on availability
of funds and is subject to change without notice of funds and is subject to change without notice

Rebate Amount $ Customer # Rebate Amount $ Customer #

BPA Contribution $ GL# BPA Contribution $ GL#
PUD Contribution $ Approved PUD Contribution $ Approved
MEF Date MEF Date