Optional information:

What was the main reason you purchased an ENERGY STAR®

qualified refrigerator or freezer? Please check one:
N energy savings N larger capacity
N available rebate N quieter operation
N like to buy the best N concerns with global
warming/climate change
N takes up less space
N other
Did you know about the rebate before you purchased
your refrigerator or freezer?
N yes N no
If so, did the rebate influence your purchase decision?
N yes N no
Why did you purchase a refrigerator or freezer at this time?
Check all that apply:

N old machine broke N remodeling

N wanted upgrade N new home
N energy savings N better performance
N new purchase (does not replace old unit)
Have you purchased other ENERGY STAR qualified products?

$25off
N yes N no
What do you plan on doing with the old refrigerator/freezer?
N recycling it N selling it
N disposing of it N giving it to a friend
N putting it in the garage or basement N other
____________________
____________________ ENERGY STAR®
Qualified Refrigerators
or Freezers

Congratulations on your decision to buy an Mail-in Rebate

ENERGY STAR qualified refrigerator or freezer. It’s
good for you, your family, and the environment.
Thank you! SAVE BIG. By choosing
Valid for purchases made January 1, 2010 – June 30, 2010. All rebate requests must be ENERGY STAR qualified products
postmarked no later than July 31, 2010. Limit: One refrigerator and one freezer rebate per you save money, energy and help
electric utility account in Vermont. Eligible refrigerator or freezer must be installed in
Vermont. For more information, call 888-921-5990. This rebate offer is available to all electric protect the environment for
utility customers in Vermont and may be subject to change without prior notice. This rebate generations to come.
may not be combined with any other Efficiency Vermont offer. Efficiency Vermont reserves
the right to conduct field inspections to verify installations. Limitation of liability: Efficiency
Vermont does not guarantee the performance of installed equipment expressly or implicitly.
In accepting these financial incentives, the customer agrees that Efficiency Vermont holds the An energy efficiency offer provided by:
sole rights to any electric system capacity credits and/or environmental credits associated with
the energy efficiency measures for which incentives have been received. These credits will be
used for the benefit of Vermont ratepayers. Limit one rebate per Vermont electric account.

Printed on 100%
RRT5h-1209 www.efficiencyvermont.com recycled paper.
www.efficiencyvermont.com • 888-921-5990
 Get cash back from us.
With a new ENERGY STAR qualified refrigerator
or freezer, you can start saving right away. For
a limited time, receive a mail-in rebate of $25!
Some restrictions may apply. Just ask your local
participating dealer for details.
Save up to $100 per year.
If you have an older refrigerator or freezer, it’s likely
that it uses more electricity than any other appliance
in your home. If your refrigerator or freezer was
manufactured more than 10 years ago, it could use
as much energy as two new ENERGY STAR qualified
models. ENERGY STAR qualified refrigerators can
save over $100 per year, and ENERGY STAR qualified
freezers can save over $80 per year, depending on
the model being replaced. See the chart below for
comparisons of sample equipment types.
The ENERGY STAR® $25 Mail-in Rebate.
Get $25 back from Efficiency Vermont on your purchase
of an eligible ENERGY STAR qualified refrigerator
or freezer. This rebate is good for purchases made
January 1, 2010 through June 30, 2010.
To receive your rebate:
1) Fill out this form completely.
2) Enclose a copy of your dated sales receipt
and a recent copy of your electric bill.
3) Mail it to the address below.
Incomplete information will delay or disqualify your rebate. All rebate
requests must be postmarked no later than July 31, 2010.
Mail to:
EFI – VT ENERGY STAR Refrigerator & Freezer Rebate
40 Washington Street, Suite 2000
Westborough, MA 01581
(Please DO NOT include rebate coupon with utility bill payment.)
Please fill out completely. All information below is required.

Typical Annual Savings from Replacing an Old Your Name

Refrigerator or Freezer with an ENERGY STAR Installation Address
Qualified Model City State Zip
Home Phone
Work Phone
$140
$120 Mailing Address (if different)
Annual Savings

$100 City State Zip

$80
$60 Please check type of appliance purchased:
$40 N Refrigerator N Freezer
$20 This refrigerator/freezer is for use in my:
$0 N Home N Business
top freezer side-by-side upright chest
refrigerator refrigerator freezer freezer House type (check one in each column):

Appliance Type N own N primary residence N condo/townhouse

N 10 yrs old N rent N vacation home N single family
N 20 yrs old N multifamily, ___ # of units
For installation address:
Your electric company
Account #
Only products delivering the highest level of Mfr. and Model # of ENERGY STAR qualified refrigerator or
energy efficiency can earn the ENERGY STAR. freezer purchased
Look for them at participating retailers.
Name and address of store where refrigerator or freezer was
Call 888-921-5990 or visit
www.efficiencyvermont.com for a complete
purchased
list of participating appliance dealers.
Purchase Price $_____________ Purchase Date ____/____/____