ENERGY STAR APPLIANCE INCENTIVE PROGRAM

Save NowFOR MORE INFORMATION ON OUR RESIDENTIAL REBATE PROGRAMS,

PLEASE CALL (319) 332-0100 OR VISIT INDYTEL.COM.

Please attach dated copy of original sales receipt.

CUSTOMER INFORMATION:

Utility Account Number (found on bill)

Name on Account

Installation Address

City State ZIP

THE EQUIPMENT WILL BE USED IN: � Single Family Home

� Apartment/Condo

� Business _______________________________________Business Name

CUSTOMER AGREEMENTMy signature indicates consent to and agreement with all program terms and conditions. It certifies that all information in this application is correct and that all of the listed new equipment has been purchased, installed and is operating at the indicated location. I understand that my utility company reserves the right to inspect and verify installation before and after issuing payment.

Customer Signature Date

QUESTIONS?Contact your local participating utility.

Get yourrebatetoday!

700 Seventh Avenue NE • PO Box 754Independence, IA 50644

www.indytel.com • (319) 332-0100

At Independence Light & Power, Telecommunications, we believe affordable public power strengthens our community and helps our neighbors. That’s why, through WPPI Energy, we’re partnering with other local not-for-profit utilities to share resources and lower costs.

ENERGY STAR® APPLIANCE INCENTIVE PROGRAM

Visit our website for a list of rebates

and downloadable forms.

WWW.INDYTEL.COM(319) 332-0100

All appliances must be ENERGY STAR® ratedto qualify. Limit one appliance type per dwelling unit.

PLEASE CHECK ONE APPLIANCE � Refrigerator .................................................................. $50

10 cubic feet or larger

� Front-Load Clothes Washer .................................$100Must use utility’s fuel for water heating

� Top-Load Clothes Washer ...................................... $35Must use utility’s fuel for water heating

� Dishwasher................................................................... $50Must use utility’s fuel for water heating

� Dehumidifier................................................................ $25

Brand

Model #

Serial #

Purchase Cost

Purchase Date

Appliance Dealer Name

Appliance Dealer City

WATER HEATING FUEL SOURCE(if clothes washer or dishwasher)� Gas � Electric � Other________________________

PROGRAM TERMS & CONDITIONSThis rebate program is being offered by Independence Light & Power, Telecommunications which will be referred to as “the utility” throughout this document.

Limit one appliance type per dwelling unit per year. Applicant must be a current customer of the utility, and the utility must provide the primary fuel for which the rebate is being offered.

The utility does not guarantee that the installation and operation of energy efficiency equipment will result in reduced usage or demand or in cost savings. The utility makes no warranties, expressed or implied, with respect to any equipment purchased and/or installed, including, but not limited to, any warranty of merchantability or fitness for a particular purpose. In no event shall the utility be liable for any incidental or consequential damages or injuries resulting from defective equipment or installation.

The rebates are offered on a first-come, first-served basis. The utility reserves the right to cancel or change these programs at any time. The utility’s acceptance of this application does not guarantee payment of the incentive. Prior to any payment of rebates, the utility reserves the right to verify sales transactions.

The utility will not be responsible for any tax liability that may be Imposed on the customer as a result of the payment of rebates.

The utility does not endorse any particular manufacturer, product, system design, claim or retailer in promoting this program.

READY TO SAVE MONEY AND REDUCE ENERGY CONSUMPTION?

HERE’S HOW:First refer to this brochure, or contact Independence Light & Power, Telecommunications (IL&P,T), to learn about program details and to learn what rebates are available.

Then select equipment based on the energy rating and terms and conditions shown in this brochure. Only approved equipment is eligible for energy efficiency rebates. After purchasing and installing qualifying equipment, please follow these simple instructions:

1. Equipment must be installed in a home where electric service is provided by IL&P,T.

2. After equipment is installed and operating, complete this Equipment Application, including signature(s).

3. Attach a sales receipt from your dealer, including manufacturer’s name, model/serial number of equipment purchased and installed.

Drop off your completed application at our office or mail it to:

Independence Light & Power, Telecommunications PO Box 754, Independence, Iowa 50644

Thank you for participating in the Residential and Small Commercial Energy Star Products Program.