CPUD: Residential Clothes Washer and Dryer Rebate Application

SEE IF YOU QUALIFY

Residence Type*

Site Built Home (4 units or less)

Manufactured Home

Multi-Family Home (5 units or more)

Multi-Family Type*

Low Rise (5 units or more, 3 stories or less)

Mid/High Rise (6 units or more, 4 stories or more)

Are the Clothes Washer and/or Clothes Dryer located in a common area of the Multi-Family home?*

Yes

No

Unfortunately, for Multi-Family homes, new Clothes Washers and Clothes Dryers must be located in a common area to qualify for the rebate.

Which new appliance(s) were purchased?*

Clothes Washer

Clothes Dryer

SEE IF YOU QUALIFY

Is the new Clothes Washer ENERGY STAR® Certified?*

Please refer to energystar.gov to learn more about ENERGY STAR® products.

Yes

No

Unfortunately, your new Clothes Washer must be ENERGY STAR® Certified to qualify for the rebate.

Water Heater Type*

Electric

Gas

Dryer Type*

Electric

Gas

SEE IF YOU QUALIFY

New Dryer Type*

Electric

Gas

Unfortunately, your new dryer must be electric to qualify for the Clothes Dryer rebate.

Is the new Clothes Dryer ENERGY STAR® Certified?*

Please refer to energystar.gov to learn more about ENERGY STAR® products.

Yes

No

Unfortunately, your new Clothes Dryer must be ENERGY STAR® Certified to qualify for the rebate.

CONGRATULATIONS!

Based on the information that you provided, your new Clothes Washer qualifies for the rebate. Please complete and submit the rest of this form to apply.

Based on the information that you provided, your new Clothes Dryer qualifies for the rebate. Please complete and submit the rest of this form to apply.

Based on the information that you provided, your new Clothes Washer and Clothes Dryer qualify for the rebates. Please complete and submit the rest of this form to apply.

NEW WASHER INFORMATION

Clothes Washer Brand*

Clothes Washer Model Number*

Quantity*

NEW DRYER INFORMATION

Clothes Dryer Brand*

Clothes Dryer Model Number*

Quantity*

UPLOAD YOUR REBATE DOCUMENTS

If you are unable to upload the required documentation, please call (888) 883-9879 or email rebates@esgroupllc.com for assistance.

Required:

Receipt(s) or invoice(s) must include brand, model number, price, and date of purchase.

Optional:

Copy of Energy Guide label for washer showing ENERGY STAR® logo.

Drop files here or

Max. file size: 20 MB.

APPLICANT INFORMATION

Utility Account Number

Name*

First Last

Are you the utility account holder?*

Yes

No

Your relationship to utility account*

Family Member

Landlord

Tenant

Other

Phone*

Email*

Enter Email Confirm Email

Installation Address*

Street Address City State ZIP Code

Do you have a different mailing address?*

My mailing address is the same as above

I have a different mailing address

Mailing Address*

Street Address City State ZIP Code

Application Notes

Please insert any notes that you would like us to review with your application. (This is not required to submit the application.)

SUBMIT YOUR APPLICATION

By submitting this form, the applicant acknowledges that they have read and agree to the utility's Terms & Conditions found at the bottom of this page.

I agree*

I agree to the Terms & Conditions