EFFICIENT DISHWASHER

REBATE Application
FOR SNOHOMISH COUNTY PUD RESIDENCES ONLY
2266D • EFFECTIVE 03/01/10

APPLICANT NAME
(FIRST, LAST) (please print) INSTALLATION ADDRESS UNIT/APT CITY ZIP CODE

MAILING ADDRESS CITY ZIP CODE

PUD ELECTRIC ACCOUNT NUMBER TO BE CREDITED HOME PHONE WORK PHONE

( ) ( )

Water heating fuel source (your answer does not affect eligibility): o Electric o Natural Gas o Propane o Solar o Other

ENERGY STAR® EFFICIENT DISHWASHER: $35 REBATE

Brand Model No.

Where purchased? Date of Purchase

TERMS OF PARTICIPATION IN THE PUD EFFICIENT APPLIANCE REBATE PROGRAM

1. Purchase a new ENERGY STAR® dishwasher on or between November 16, 2009, and December 31, 2010. A list of qualifying models
can be found at www.energystar.gov or by calling our Energy Hotline during business hours (see below).
2. The efficient dishwasher has been installed at a residence with an active PUD residential account.
3. To make a rebate claim, fill out and return this application form along with a legible copy of the purchase receipt that shows brand
name, model number and date of purchase.
4. Mail rebate claim so that it is received by the PUD within ninety (90) days from the purchase date to: Snohomish County PUD,
Appliance Rebates, PO Box 1107, Everett WA 98206-1107. You should keep a copy for your records.
5. Allow at least six (6) weeks for processing of your PUD efficient appliance rebate. Once processed, a credit will be applied to the PUD
account number listed above.
6. The PUD reserves the right to inspect and approve dishwashers receiving a rebate for conformity to program requirements.
7. The efficient appliance rebate program may be cancelled at any time and is subject to the availability of funds.
8. Sign and date the dishwasher rebate form. Your signature below indicates that all information supplied is true and correct and you have
read and accepted the terms of participating in the PUD’s efficient appliance rebate program.

How did you hear about our EFFICIENT APPLIANCE REBATE program? (Please check all that apply.)
o Ad (TV, print, etc.) o PUD Bill Insert o PUD Brochure o Contractor or Retailer o Postcard o Email o PUD Web site
o “Current” Magazine o PUD Employee o Fair or Event o Friend or Family o Energy Hotline o Letter o News story
APPLICANT SIGNATURE (see below if submitting electronically) DATE

If submitting electronically: By checking this box, the Applicant certifies under penalty of perjury under the laws of the State of Washington that the
information provided above is true and correct. ALL APPLICATIONS MUST EITHER BE SIGNED OR HAVE THIS BOX CHECKED.

WWW.SNOPUD.COM/APPLIANCEREBATES
ENERGY HOTLINE: 425-783-1700, Monday - Friday, 8 am to 5 pm
(toll-free in Western Washington and outside the local Everett calling area at 1-877-783-1000)

FOR OFFICE USE ONLY

DEVICE NUMBER NOTIFICATION NUMBER

BP NUMBER CONTRACT ACCOUNT NUMBER CREDIT NUMBER