LAKE COUNTRY POWER Residential ENERGY STAR® 2019 Refrigerator/Freezer/Dehumidifier Rebate Application Important: - Limit one rebate per appliance per account. - The appliance(s) must be installed within Lake Country Power service territory. - Fill out this form completely. Incomplete forms will not be processed. - Please submit within 90 days of purchase: A copy of the original dated sales receipt showing item purchased A recycling receipt for refrigerator / freezer -To: Lake Country Power OR Lake Country Power OR Lake Country Power 2810 Elida Drive 8535 Park Ridge Drive 4065 Highway 73 South Grand Rapids MN 55744 Mountain Iron MN 55768 Kettle River MN 55757
- Rebate Amounts: Replacement Refrigerator with recycling $25 Replacement Freezer with recycling $25 Refrigerator or Freezer - Recycling only $25 Dehumidifier - Energy Star $25 Clothes Dryer - Energy Star $25 WiFi Thermostat $25 Member Information: Name: Account #: <-- required Address where appliance is installed:
City: State: Zip: Phone Number:
By signing this application, I certify the appliances for which I am claiming a rebate are qualifying ENERGY STAR® rated products and are installed at the address listed above which represents a valid cooperative account.
Signature: Today's date:
Equipment Information: Freezer - with recycling receipt New Freezer--> Manufacturer: Model Number:
1. Did this rebate influence your decision to buy this appliance? Yes No
Refrigerator - with recycling receipt New Refrigerator--> Manufacturer: Model Number:
1. Did this rebate influence your decision to buy this appliance? Yes No
Refrigerator - Recycling Only no purchase nessary but you must provide a recycling receipt for the recycled appliance Freezer - Recycling Only no purchase nessary but you must provide a recycling receipt for the recycled appliance Dehumidifier Manufacturer: Model Number:
1. Did this rebate influence your decision to buy this appliance? Yes No Clothes Dryer Manufacturer: Model Number:
1. Did this rebate influence your decision to buy this appliance? Yes No WiFi Thermostat Manufacturer: Model Number:
1. Did this rebate influence your decision to buy this appliance? Yes No
Retailer Information:
Retailer/Store Name: Location:
Rebates are available only for the purchase of new ENERGY STAR® rated products purchased on or after January 1, 2019. The products must be installed where electricity is supplied by Lake Country Power. Rebate submittal must follow the guidelines as listed above. Lake Country Power is not responsible for inaccurate information supplied by appliance dealers. Rebates will be issued only for products on the current list of ENERGY STAR® rated products as of the purchase date. ENERGY STAR® occasionally removes products from qualifying lists, and Lake Country Power will not rebate products that have been delisted as of the purchase date or are mislabeled as ENERGY STAR®. To verify ENERGY STAR® certification for appliances and lighting, visit www.energystar.gov or call 1-888-STAR-YES. To verify ENERGY STAR® certification for ductless air source heat pumps, visit http://www.ceedirectory.org/ceedirectory. Rebate program is subject to change or cancellation without notice. Call Lake Country Power to verify rebate program status. 800-421-9959 Please allow up to 4 weeks for processing. Rebate will be applied as credit to account