Phone: 320-763-6501www.alputilities.com

316 Fillmore Street • Alexandria, MN 56308

RESIDENTIAL ENERGY STAR REBATE APPLICATION

Submit completed application form and copy of sales receipt to:316 Fillmore Street • Alexandria, MN 56308

Must be postmarked within 60 days of purchase. All rebates will be applied to the customer’s electric account.

CUSTOMER INFORMATIONName _______________________________________________________ Account No. __________________________

Street Address ______________________________________________________________________________________

City_________________________ State ________ Zip __________ Daytime Phone Number ____________________

Address of Installation, if different __________________________________________________________________

This equipment will be used in a: r Single Family Home r Apartment/Condo Building

Water Heating Source: r Electric r Gas r Propane r Other___________________________________________(water heater source is required information for ALP reporting to Minnesota Dept. of Commerce)

Signature: __________________________________________________________________________________________

How did you hear about these ENERGY STAR® rebates? r Radio r Newspaper

r Retailer/Vendor r Contractor r Utility Representative r Utility Web Site r Utility Newsletter

CLOTHES WASHER: $25 (must be ENERGY STAR ® approved)

What is your water heater fuel source? r Electric r Gas r LP

BRAND:________________________ Model No. ________________________ Serial #: (required) _______________

ELECTRIC CLOTHES DRYER: $25 Electric only. Gas or propane dryers do not qualify. (must be ENERGY STAR ® approved)

BRAND:________________________ Model No. ________________________ Serial #: (required) _______________

REFRIGERATOR: $25 (must be ENERGY STAR ® approved)

BRAND:________________________ Model No. ________________________ Serial #: (required) _______________

DEHUMIDIFIER: $25 (must be ENERGY STAR ® approved)

BRAND:________________________ Model No. ________________________ Serial #: (required) _______________

ROOM/WINDOW AIR CONDITIONER: $25 (must be ENERGY STAR ® approved)

BRAND:________________________ Model No. ________________________ Serial #: (required) _______________

Terms and Conditions• The appliance must be installed within ALP Utilities’ service territory.• One rebate per appliance.• All rebates will be applied to customer’s electric account.

Allow 6 – 8 weeks for processing. Incomplete forms will not be processed for rebate.

• A copy of the original dated sales receipt must be

included with application.• ALP does not warrant the performance of installed equipment.• Offer may be subject to change without prior notice.

Energy Star rebates are also available for the following items but require using the appropriate rebate form. The forms can be download from our website: alputilites.com/residential/rebates.php LED Lighting: $2 - $4 Air Source Heat Pumps: $250 -$450“Smart” Thermostats: $25 Geothermal Heat Pumps: $200/tonCentral Air Conditioners: $250-$450 ECM’s in Furnaces or Air Handlers/Fan Coils: $150Central AC or Heat Pump Tune-Ups: $30 Heat Pump Water Heater ≤ 55 gallons: $250

Applicant Signature _____________________________________________________________ Date __________________________