Optional Information:

Mail-in
What was the main reason you purchased a select
ENERGY STAR® Qualified Refrigerator or Freezer?
Please check one:
N energy savings N larger capacity

Rebate
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

50
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 ENERGY STAR® Qualified
N new purchase (does not replace old unit) Refrigerators or Freezers
Have you purchased other ENERGY STAR qualified products?
N yes N no
How did you hear about ENERGY STAR Qualified
Refrigerators or Freezers? Check all that apply:
N newspaper ad N TV ad
N web site N utility bill insert
N retailer/salesperson N friend/relative/co-worker
N news report/article N other
N magazine ad
Email Address
N Yes! Sign me up to receive energy saving and incentive
information from myenergystar.com.

Congratulations on your decision to buy

an ENERGY STAR Qualified Refrigerator or
Freezer. It's good for you, your family, and
the environment. Thank you!
Valid for purchases made January 1, 2010 - December 31, 2010. All rebate requests must be postmarked no later than
January 31, 2011. Limit: One refrigerator and one freezer rebate per Massachusetts residential account per calendar year.
Eligible refrigerator or freezer must be installed in Massachusetts. Refrigerator must be 7.75 cu. ft. or larger to be eligible.
Excludes compact models. For more information, call: 1-877-ESTAR 4 U (378-2748). This rebate offer is available to all This rebate is for the benefit of Massachusetts customers of:
Massachusetts residential customers of participating utilities and energy efficiency service providers and may be
subject to change without prior notice. This rebate may not be combined with any other utility or energy efficiency
service provider offer; however, it can be combined with American Recovery and Reinvestment Act (ARRA) incentives.
The participating utility or energy efficiency service provider reserves the right to conduct field inspections to verify
installations. Limitation of liability: Participating utility or energy efficiency service provider does not guarantee the
performance of installed equipment expressly or implicitly. Customer agrees that the Energy Efficiency Program
Provider (EEPP) has the unilateral right to apply for any ISO-NE capacity payments or environmental credits resulting
from this energy efficiency project, and agrees not to file for such payments or credits either directly or indirectly.
Manufacturer and/or retailer agree to provide the EEPP with such further documentation as the EEPP may request to
confirm the EEPP's ownership of such benefits.

Printed on 100%
myenergystar.com recycled paper. A-9 12-09

Get cash back from us.
With a new ENERGY STAR qualified
refrigerator, you can start saving right away.
For a limited time, receive a mail-in rebate
of $50! Some restrictions may apply. Just ask
your local participating retailer for details.
A fridge made before 1993 could be costing
you approximately $300 each year to operate,
depending on the size and model year. Replace
it with a new ENERGY STAR qualified model
and cut your related energy costs in half. See
the chart below for comparisons of sample
The ENERGY STAR® $50 Mail-in Rebate.
Get $50 back from participating utility or energy
efficiency service provider on your purchase of an
eligible ENERGY STAR Qualified Refrigerator or Freezer.
This rebate is good for purchases made January 1, 2010
through December 31, 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 January 31, 2011.

equipment types, including savings associated Mail to:

with ENERGY STAR qualified freezers. EFI – MA ENERGY STAR Refrigerator/Freezer Rebate
40 Washington Street, Suite 2000
Westborough, MA 01581
Typical Annual Savings from Replacing an
Old Refrigerator or Freezer with an ENERGY (Please DO NOT include rebate coupon with utility bill payment.)
STAR Qualified Model of Equal Size Please fill out completely. All information below is required.
Your Name
$300 Account/Installation Address
250 City State Zip
Home Phone
200
Annual Savings

Work Phone
150
Mailing Address (if different)
100 City State Zip
50 House type (check one in each row):
$0
Top Freezer Bottom Side-by-Side Chest
N own N rent
Refrigerator Freezer
Refrigerator
Refrigerator Freezer N primary residence N vacation home
N single family N condo/ N multifamily
townhouse ___ # of units
Appliance Type
Year of Purchase
For installation address:

N Pre-1993 Your energy efficiency provider (check one):

N 1993-2000 N NSTAR N Western Massachusetts Electric
N 2001-2008 N Unitil N Cape Light Compact N National Grid
Account #
Mfr. and Model # of ENERGY STAR Qualified Refrigerator
Only products delivering the highest level
of energy efficiency can earn the ENERGY or Freezer purchased
STAR. Look for them at participating Name and address of store where refrigerator or freezer
retailers. Call 1-877-ESTAR 4 U (378-2748)
was purchased
or visit myenergystar.com for a complete
list of participating appliance retailers.
Purchase Price $______ Purchase Date ____/____/____