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2. 
4. Rebate Policy
   * Residential ENERGY STAR® Clothes washer Rebate

   * Residential ENERGY STAR® Refrigerator/Freezer Rebate
   
   * Residential ENERGY STAR® Dishwasher Rebate

   Check out the Rules & Requirements section to make sure you qualify for this rebate before filling out the form.

6. Check this box to acknowledge that you have read and agree to our rebate policy Rules & Requirements.*

   1. Yes

8. Submitting this document electronically will require you to upload documentation such as sales receipt, etc.  Please do not send sensitive information.

10. Select Qualifying Purchase Date:*

    1. Receipt dated within last 12 months.
    2. Receipt older than 12 months from current date. (Sorry does not qualify)

    Customers must apply for rebates within twelve (12) months of the purchase date shown on the sales receipt.

14. Anoka Municipal Utility (AMU) Customer Information

    You must have an address that is serviced by Anoka Municipal Utility (AMU). 

16. Anoka Municipal Utility (AMU) is my electric service provider.*

    1. Yes
    2. No, sorry this rebate is for AMU customers only.
18. Customer First Name*
19. Customer Last Name*
21. Service Address*

    Rebate amount will be credited to your AMU billing account. No need for a mailing address. This must be the location of installation for the rebate. 

23. Building Type*

    1. Single Family

    1. Multi-Family (Apartment/Townhome/Duplex)
24. Building/Apartment Number
26. City*
27. State
28. Zip*
30. Phone Number*
31. Email Address
35. Retailer Information
37. Retailer Name/Store:*
39. Location/City*
40. State
42. Receipt Date*
    Receipt Date
44. Upload Your Receipt*

    Receipt(s) submitted must include Retailer Information and Purchase date along with product information for proof of purchase.

    Take a picture from your phone, a screen shot, or scanned copy of original receipt. 

46. Upload more Documentation 1 (optional)
48. Upload more Documentation 2 (optional)
52. Equipment Information
54. Select the appliance type for rebate*

    Limit one of each type per account per calendar year. 

    1. Clotheswasher
    2. Dishwasher
    3. Refrigerator/Freezer
56. Select One*

    1. Refrigerator
    2. Freezer
58. Is your appliance ENERGY STAR®*

    1. Yes
    2. No (sorry, does not qualify)
60. Unit Size

    1. Standard
    2. Compact
61. Water Heating Element

    1. Electric
    2. Gas
62. Type of Dryer Used in home

    1. Electric
    2. Gas
64. Manufacturer*
65. Model Number*
66. Serial Number
68. Capacity (in cubic feet)
70. Replacement Appliance?

    1. Yes
    2. No
71. How old was the model it replaced?

    Estimate if unsure.

    1. Before 1980
    2. 1981 to 1990
    3. 1991 to 2000

    1. 2001 to 2007
    2. 2008 to Present
72. Old Appliance Status

    1. Fully Working
    2. Not Working Properly
    3. Does Not Work
74. Recycled Old Appliance?*

    1. Yes
    2. No

    Refrigerators/Freezers may receive an additional $50.00 rebate for a Recycled Appliance. 
    Notice: AMU reserves the right to verify recycling drop-offs and pick-ups from the reported address indicated on this form.

76. Date appliance hauled off
    Date appliance hauled off
77. Name of Hauler

    Hauler or Retailer Name that appliance was picked up on behalf of, or dropped off at.

79. Certification of De-Manufacturing*

    1. I certify the following statement is accurate and true.

    By checking this box, I certify this appliance has or will be turned over to a licensed recycler and removed from the grid (not resold or reused). To the best of my knowledge the appliance will be fully decommissioned including refrigeration and mercury components and refrigerants and CFC’s recycled following federal, state and local laws. I attest the following information is accurate and true and that this appliance was or will be turned in by the date above, and verified by the applicant listed on this rebate form.

83. Disclaimer & Signature
85. Check this box to agree to the following:*

    1. I certify that all the information provided is accurate including claims of efficiency, size and customer information. I agree that AMU may verify all the information I have provided.
87. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
89. Customer Electronic Signature*
Leave This Blank:


91. 1. Receive an email copy of this form.
92. Email address

    This field is not part of the form submission.

93. Submit Submit and Print

* indicates a required field