STAPLE HERE Mail Completed Form, copy of Sales Receipt and copy of EnergyGuide Label to: Laurie Anderson MMED 125 High Street; Unit # 2 Mansfield, MA 02048		FOR OFFICE USE ONLY Cycle # ________ Book # ________ Seq # ________ TC# ________ Refund $ ________ Ref Date ________
Mansfield Municipal Electric Department ENERGY STAR Appliance Rebate Incentive Program Customer Application
Customer Name: ________________________________ Home Phone: _______________________________ (as it appears on electric account) Address: ______________________________________ Work Phone: _______________________________ Town: ________________________________________ Account Number: ___________________________ New ENERGY STAR Appliance Information Appliance purchased: ____ Central Air Conditioner ____ Refrigerator ____ Clothes Washer (please check) ____ Dishwasher ____ Dehumidifier ____ Window Air Conditioner ____ Programmable Clock Thermostat Brand: ____________________________ Model: __________________________________ Date of Purchase: __________________ Store: ___________________________________ If Refrig., size (cubic ft.): ____________ Style: __ Top __ Bottom __ Side by Side If A/C, size (BTUs): ________________ Energy Efficiency Rating (S)EER): _________ Information on Appliance New Purchase Is Replacing Brand: __________________________ Model: _________________________________ Approximate Age: ________________ If A/C, size (BTUs): ______________________ If Refrigerator, size (cubic ft.): _____ Style: __ Top Freezer __ Bottom Freezer __ Side-by-Side
Please allow 4 to 6 weeks for processing of Rebate. It will appear as a credit on your Electric bill. Please remember to attach a copy of your Sales Receipt along with a copy of the EnergyGuide Label to this application for processing.

ENERGY STAR APPLIANCE REBATE INCENTIVE

Mansfield Municipal Electric Department (MMED) is pleased to offer rebates to customers purchasing selected energy efficient ENERGY STAR central air conditioners, refrigerators, clothes washing machines, dishwashers, dehumidifiers, window air conditioners and programmable clock thermostats. ENERGY STAR appliances have been defined by the Department of Energy (DOE) as being significantly more energy efficient than the average comparable model. The advantages of purchasing ENERGY STAR appliances include:

Potential savings in energy costs of between 15 and 50%

Reduction of global energy consumption and need for additional generation

Decrease in pollution from fossil fuels used to generate electricity

This offer is available for a limited time only. ENERGY STAR appliances must be purchased between the dates of January 1, 2003 and December 31, 2008 in order to qualify for a rebate.

ELIGIBILITY CRITERIA

CENTRAL AIR CONDITIONERS

Qualified ENERGY STAR central air conditioners are eligible for a $100.00 rebate.

REFRIGERATORS

Qualified ENERGY STAR refrigerators are eligible for a $100.00 rebate.

CLOTHES WASHING MACHINES

Qualified ENERGY STAR clothes washing machines are eligible for a $100.00 rebate.

DISHWASHERS

Qualified ENERGY STAR dishwashers are eligible for a $75.00 rebate.

DEHUMIDIFIERS

Qualified ENERGY STAR dehumidifiers are eligible for a $50.00 rebate.

WINDOW AIR CONDITIONERS

Qualified ENERGY STAR air conditioners are eligible for a $50.00 rebate.

PROGRAMMABLE CLOCK THERMOSTATS

Qualified ENERGY STAR programmable clock thermostats are eligible for a $25.00 rebate.

MMED reserves the right to change any portion of this program or end the program at any time without notice.

REBATE ELIGIBILITY REQUIREMENTS

* Customers must have an active residential account with Mansfield Municipal Electric Department.

* Only selected ENERGY STAR central air conditioners, refrigerators, clothes washing machines, dishwashers, dehumidifiers, window air conditioners, and programmable clock thermostats are eligible for rebates. Appliances that may qualify will have the ENERGY STAR logo on the yellow EnergyGuide label attached to the appliance.

* Proof of purchase in the form of a sales receipt dated between January 1, 2003 and December 31, 2008, a copy of the EnergyGuide label from the appliance purchased and a completed Mansfield Municipal Electric Department’s ENERGY STAR Appliance Rebate Incentive Application will be required in order to be eligible for a rebate.

* Offer limited to a TOTAL of $100.00 worth of ENERGY STAR appliance rebates per customer account for appliances purchased in the same calendar year.

* Appliance must be installed at the account location.

* Mansfield Municipal Electric Department reserves the right to inspect the installation on premises.

If you have any questions, please contact Laurie Anderson at 508-261-7361 ext. 301.

Did you know...

An ENERGY STAR refrigerator uses half the electricity of a standard 10-year old refrigerator and can reduce your electricity bill by $25-$50 a year compared to the old model. In most homes the refrigerator uses more electric energy than any other single appliance, so switching to an ENERGY STAR labeled refrigerator can potentially save you up to $100 per year on your electric bill.

Did you know...

ENERGY STAR qualified clothes washers use 50 – 70% less energy than other models through better

design and reduction of hot water needs. This could save up to $90. a year in energy and water costs.

Did you know...

An ENERGY STAR qualified window air conditioning unit can reduce energy consumption (and

environmental emissions) by 20% to 50%. The most efficient air conditioners on the market are

up to 70% more efficient than the current average room air conditioner.

Did you know...

Replacing a 10-year old dishwasher with an ENERGY STAR qualified dishwasher can save you more

than $30 a year in energy costs.

Did you know...

ENERGY STAR programmable clock thermostats can save you $100. per year and keep your home

comfortable by automatically adjusting your temperature settings while you are asleep or away.

Did you know...

ENERGY STAR qualified central air conditioners have higher seasonal efficiency rating (SEER) than standard models, which make them about 25% more efficient.

Did you know...

A 40-pint ENERGY STAR qualified dehumidifier can save consumers roughly $20 per year. This can add up to $200 or more over 10 year life of the unit. That’s enough to pay for the dehumidifier!