Form Center

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

3. 
5. Rebate Policy
   Residential LED Lights Rebate

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

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

   1. Yes
9. 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.

13. Anoka Municipal Utility (AMU) Customer Information

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

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

    1. Yes
    2. No, sorry this rebate is for AMU customers only.
17. Customer First Name*
18. Customer Last Name*
20. 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. 

22. Building Type*

    1. Single Family

    1. Multi-Family (Apartment/Townhome/Duplex)
23. Building/Apartment Number
25. City*
26. State
27. Zip*
29. Phone Number*
30. Email Address
34. Retailer Information
36. Retailer Name/Store:*
38. Location/City*
39. State
41. Receipt Date*
    Receipt Date
43. 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. 

45. Upload Another Receipt?*

    1. Yes
    2. No
47. Retailer Name/Store
49. Receipt Date
    Receipt Date
51. Upload Receipt #2 (optional)
53. Upload Another Receipt?*

    1. Yes
    2. No
55. Retailer Name/Store
57. Receipt Date
    Receipt Date
59. Upload Receipt #3 (optional)
61. Upload Another Receipt?*

    1. Yes
    2. No
63. Retailer Name/Store
65. Receipt Date
    Receipt Date
67. Upload Receipt #4 (optional)
69. Upload Another Receipt?*

    1. Yes
    2. No
71. Retailer Name/Store
73. Receipt Date
    Receipt Date
75. Upload Receipt #5 (optional)
79. Equipment Information

    Bulbs must save energy to qualify.  Limit of $50.00 rebate per year.

81. Energy Saving LED Bulbs?*

    1. Yes
    2. No (sorry these do not qualify)

    Replacement bulb less wattage than previous bulb. Does not need to be ENERGY STAR®.

83. Installation Date*
    Installation Date
85. Quantity of Packages*
86. Quantity of Bulbs per Package*
87. Cost per Package*
89. Old bulb wattage*

    Find on LED package or Replacement bulb wattage

90. New LED wattage*

    Find on LED package

91. Total Rebate for First Bulb Type

    Cost per package x Quantity of Packages

93. Add Another Bulb Type?*

    1. No

    1. Yes, add more LED bulbs to my rebate amount.
95. Quantity of Packages*
96. Quantity of Bulbs per Package*
97. Cost per Package*
99. Old bulb wattage*
100. New LED wattage*
101. Total Rebate for Second Bulb Type*
103. Add Another Bulb Type?*

     1. No

     1. Yes, add more LED bulbs to my rebate amount.
105. Quantity of Packages*
106. Quantity of Bulbs per Package*
107. Cost per Package*
109. Old bulb wattage*
110. New LED wattage*
111. Total Rebate for Third Bulb Type*
113. Add Another Bulb Type?*

     1. No

     1. Yes, add more LED bulbs to my rebate amount.
115. Quantity of Packages*
116. Quantity of Bulbs per Package*
117. Cost per Package*
119. Old bulb wattage*
120. New LED wattage*
121. Total Rebate for Fourth Bulb Type*
123. Add Another Bulb Type?*

     1. No

     1. Yes, add more LED bulbs to my rebate amount.
125. Quantity of Packages*
126. Quantity of Bulbs per Package*
127. Cost per Package*
129. Old bulb wattage*
130. New LED wattage*
131. Total Rebate for Fifth Bulb Type*
133. Rebate Grand Total

     (Limit of $50.00 per year)

     If rebate is approved,  amount will be credited to your AMU billing account.

137. Disclaimer & Signature
139. 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.
141. 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.
143. Customer Electronic Signature*
Leave This Blank:


145. 1. Receive an email copy of this form.
146. Email address

     This field is not part of the form submission.

147. Submit Submit and Print

* indicates a required field