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1. Please provide a copy of your receipt indicating qualifying brand name and model number.
Mailing Address (if different than installation address) Apt.#/Spc.# City, State, Zip
*I certify that the appliances listed were purchased for installation at the above address, and that they meet the
program standards printed on the back of this form. Furthermore, if requested, I will allow a representative of
Eugene Water & Electric Board to verify the appliance at the installation address stated above.
Please complete separate coupons for each installation address. Appliances must be purchased by September 30,
2009, and installed within the EWEB electric service area. Coupons must be submitted within 90 days of purchase.
Program standards are listed on the back of this form. Please allow four to six weeks to receive your rebate.
This area for office use only.
To qualify for rebates, eligible appliances meeting the following standards must be purchased by
September 30, 2009, and installed within EWEB's electric service area. Coupons must be submitted
within 90 days of purchase.
To qualify for a rebate, ENERGY STAR® clothes washers shall have a Modified
Clothes Washer Energy Factor > 1.72 and a Water Factor < 8.0.
EF = energy factor
Qualifying ENERGY STAR models may be found at www.energystar.gov. Qualifying electric water heaters are rated for equipment
efficiency, and the manufacturers’ data can be found on the Gas Appliance Manufacturers’ Association web site at
http://www.gamanet.org/. Models qualifying for the Oregon Residential Energy Tax Credit may be found at
http://egov.oregon.gov/ENERGY/CONS/RES/tax/appliances.shtml
Coupons must be submitted within 90 days of purchase to EWEB, Energy Management Services,
P.O. Box 10148, Eugene, Oregon 97440-2148. For more information about EWEB’s Home Appliance Rebate Program or other
EWEB Energy Management programs, please call us at 484-1125 or visit www.eweb.org.