Appliance Rebate Form United Electric offers a $25 rebate when you purchase a qualifying Energy Star washer. To qualify for a rebate you must: Install washer within the United Electric Co-op service territory. Washer must be an approved Energy Star product. Qualifying washers can be found at the ENERGY STAR website or ask your local retailer. Complete this form and provide us with copy of your store receipt, listing the manufacturer and model number. Application must be submitted within 6 months of purchase. Name(Required) First Last Account Number(Required) Phone(Required)Mailing Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Installation Address(Required) Same as previous Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Manufacturer(Required) Model Number(Required) MEF Number(Required) Please check the applicable boxes:(Required) I use an electric water heater where this appliance is installed I use a gas water heater where this appliance is installed I use an electric clothes dryer where this appliance is installed I use a gas clothes dryer where this appliance is installed Select AllSales Receipt(Required)Max. file size: 300 MB.Member Consent(Required) I hereby verify the information to be true and complete and agree to the terms and conditions. I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today’s date and authorized by me as if I had signed my signature.I certify that the washer listed above was purchased for installation at the above address located within the United Electric Co-op service territory. I will allow a representative of United Electric Co-op to verify installation of the above listed clothes washer upon request.Member Electronic Signature (Full Name)(Required) EmailThis field is for validation purposes and should be left unchanged. Associated Content Here is my quote Here is my document (PDF) (000) 000-0000 Email Chris View More Rebates
