Residential Appliance Rebate Form

WMGLD Customer Name (required)

12-digit WMGLD Account Number (required)

Email (required)

Phone

Street Address

City/town

Please select the appropriate rebate from the drop-down list below. (Please use a separate form for each purchased appliance)

—Please choose an option—programmable-thermostat ($25)dishwasher ($25)clothes-dryer ($50)refrigerator ($50)washing-machine ($50)room-air-conditioner ($50)dehumidifier ($50)induction-range ($100)induction-range-replacing-gas ($500)heat-pump-water-heater ($500)

Brand

Model #

If you are replacing gas oven with induction range, please submit before and after pictures of stove replacement to verify replacement of gas.

Please attach sales receipt, and Energy Star Label (Energy Star Label not necessary for Induction Range).

Attachment (5MB max.):

Attachment (5MB max.):

Attachment (5MB max.):

Attachment (5MB max.):

Appliance

Age

By clicking the "Submit Application" button, I certify that I purchased the appliance noted above for the
installation address above and I am an electric customer of the WMGLD. 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.

Appliances MUST be installed at the account location.
WMGLD reserves the right to inspect the installation on the premises. Programs may
change at any time; check the website www.wmgld.com for any updates or changes
to the program.

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