Chicopee Electric Light

2009 Energy Star® Appliance Mail-In Form

Appliance Rebates:
Please fill out completely and mail to:
Clothes Washer
EFI Municipal Appliance Rebates Front Load ....................................... $50
40 Washington Street, Suite 2000 Top Load.......................................... $50
Westborough, MA 01581-1013 Refrigerator
12 cf. or Larger ............................... $50
Do not mail this rebate form with utility bill payment
Freezer
All information below is required to receive 12 cf. or Larger ............................... $50
Rebate for Energy Star® appliances. Dishwasher ..................................... $50
Programmable
Residential Electric Utility Account #:
Thermostat .............................. $25
Your Name:
Window AC
Utility account/installation address (Please do not list P.O. Box #) Size (7,500 BTU+) &
Street Address: EER Rating (10+)............................. $25
City/Town: State: Zip: Central Air Conditioner
Home Phone: Work: SEER rating (14+).......................... $100
Rebate mailing address (if different from installation address) Additional conditions apply - call for
Street Address: details.
City/Town: State: Zip: One rebate per each of the above annually,
per account of record. Appliance cost
(excluding thermostats) must be greater
USE A SEPARATE FORM FOR EACH APPLIANCE BELOW than twice the rebate for appliance. No
 Central AC  Dishwasher  Programmable thermostat, having a price less than the
rebate, is eligible for a rebate.
 Clothes Washer-Top ($50)  Freezer Thermostat
_________________
 Clothes Washer-Front ($50)  Room AC  Refrigerator
How to get your $$$
Brand: Model #: (Required for Processing)
Serial #: 1. Mail In:
Central AC Compressor #_______________Central AC Evaporator #______________ a. Completed form(s) to the
address above
(Rebate will not be processed without the serial number)
b. Copy of your dated sales
Name and address of store where appliance was purchased receipt
Store Name: c. Copy of your recent electric
Store Street Address: bill
Store City/Town: State: Zip: 2. Allow 6 – 8 weeks for processing
Purchase Price: Purchase Date: _________________

By signing this form, I certify that I purchased the appliance noted above for the Call 888 333-7525
installation address above and I am an electric customer of the utility listed above. for more information
I am providing the requested information solely to be eligible to participate in this
program and request that the personal information supplied by me be treated as
confidential to the maximum extent possible. ƒ Qualified appliances must be
purchased between 01/01/09
Customer Signature (please sign here):
and 12/31/09 and postmarked
by 01/16/10.
Only Energy Star® Appliances are eligible to receive a rebate. ƒ The utility reserves the right to
end these rebates at any time.
Residential Customers only are eligible to receive Appliance Rebates. Appliance eligibility is based solely
on the appliance list at
Appliances included in the purchase of a residence are not eligible.
www.energystar.gov/
 Chicopee Electric Light
2009 Energy Star® Appliance Mail-In Form

Central AC Rebates Eligibility:

Units with a SEER (Seasonal Energy Efficiency Ratio) of 14 or greater that are listed as
Resi Residential Energy Star (current) at www.ceehvacdirectory.org/ac.php.

REBATE $100

Additional Central Air Conditioner Requirements:

1. Installer/Homeowner must verify that both Condenser SEER and Evaporator SEER meet
the eligibility standards found at: www.ceehvacdirectory.org/ac.php.

2. Provide both condensing unit and evaporator unit model numbers on rebate form.

3. Only those units listed under Tier 1, Tier 2 or Residential Energy Star (current) are
eligible for a rebate. (Use web address above.)

4. Attach receipts to rebate form. Receipt must show the equipment installed.

5. Eligible equipment must be presently listed as Energy Star compliant.

6. Call 888-333-7525 with questions and assistance.

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