Washers $50

Residential Please
Certified* Dishwashers $50
Rebate for Refrigerators $50 Print
Freezers $25
Rebate eligible appliances must be currently listed* on the official www.energystar.gov website.
*Please see Side 2 for information on official ENERGY STAR® certification.
Eligible appliances must have been purchased in the past 365 days. This 2009 rebate coupon expires 12/15/09.

♦♦♦Appliances must be installed ♦♦♦ Itemized complete receipts showing payment in full are required
♦♦♦ Incomplete/ineligible forms will be returned ♦♦♦ Current ENERGY STAR® certification required*
Rebate Requirements: please check as applicable 4. □ I’ve attached full copies of itemized receipts
showing payment in full for each appliance.
1. □ I am currently a Clallam County PUD customer. 5. □ The rebate appliances are now installed at the
2. □ I’ve listed the PUD Appliance Code* or attached PUD service address listed below.
the energystar.gov listing page for each appliance. 6. □ I use an electric clothes dryer at the below
service address. (Required for Washer Rebate)
3. □ The below appliances were new at the time of 7. □ An electric H2O heater supplies the Washer &/or
purchase and purchased within the past 365 days. Dishwasher listed below. (Required for Rebate)

Please circle one appliance per line: WM=Washer DW=Dishwasher RF=Refrigerator FZ=Freezer
WM DW RF FZ Please Print
Brand Name Model # PUD Appliance Code* Date Installed

WM DW RF FZ Please Print
Brand Name Model # PUD Appliance Code* Date Installed

WM DW RF FZ Please Print
Brand Name Model # PUD Appliance Code* Date Installed

With my signature below, I certify that: 1) the information I’ve provided is accurate and complete; 2) I understand that
Clallam County PUD (PUD) can only issue rebates for installed eligible appliances with current official* ENERGY STAR®
certification; & 3) I will allow a PUD &/or Bonneville Power Administration Rep to verify installation of said appliance(s).
Please Print Please Print
Name on Utility Account Service Address Where Installed City Zip Code

Please Print
Name of Rebate Claimant Signature of Recipient Phone # PUD Account #

Check if
Same Please Print
Rebate Recipient’s Mailing Address City State Zip Code

Return form with required attachments to your local PUD office -OR- PUD Rebates, POB 1090, Port Angeles, WA 98362
I hereby certify under penalty of perjury that to the
best of my knowledge, the materials have been PUD Office Use Only Expense Distribution:
furnished, the services rendered or the labor 908405.6481.1 Washer Rebate $
performed as described herein, and that the claim
is a just, due and unpaid obligation against PUD 908405.6481.2 Dishwasher Rebate $
#1 of Clallam County, and I am authorized to Voucher No.
authenticate & certify said claim.
908405.6481.4 Refrigerator Rebate $
Warrant No.
Approved
908405.6481.6 Freezer Rebate $
Fund:
Date: Total: $
*ENERGY STAR® Certification Verification Methods:
Rebates can only be issued for appliances with current ENERGY STAR® certification demonstrated by
listing(s) on the official ENERGY STAR® website (www.energystar.gov). The PUD offers the following
ENERGY STAR® verification methods to help you ensure that your appliance(s) is/are eligible for the rebate:
Please note: 1) New models for 2009/late 2008 may take a few months to appear on ENERGY STAR® appliance lists.
2) Asterisks *on ENERGY STAR ®
lists are “wild cards”; they mean, “Insert any letter or number here.”

ENERGY STAR® Certification Verification: Without the Internet

1) Contact a participating* Clallam County Appliance vendor and request the PUD Appliance Code(s) for your
appliance(s). Participating vendors have been instructed to provide our mutual customers with these codes.
*Pacific Refrigeration, Sears, Home Depot, Costco, Designed for Living
2) Visit any PUD office to review their PUD Appliance Code(s) Binder. This binder -- updated at least six times per
year -- will contain printouts of rebate eligible appliances from the official ENERGY STAR® website.
a. Select the appliance category you’re seeking
b. Review the list of appliances alphabetized by brand name.
i. Note: Some GE Appliances may be listed under their model series, e.g., Profile, Café, etc.
c. Find the PUD Appliance Code for the appliance; write it down on Side 1 of this form in the space provided
next to the corresponding appliance.
ENERGY STAR® Certification Verification: Using the Internet
1) Visit the PUD’s ENERGY STAR® Appliance Rebate webpage at: www.clallampud.net/conservation
a. Select the PUD Appliance Code link for the appliance category you’re seeking.
b. Follow steps 2b and 2c above.
2) Visit the source of the above PUD Appliance Code listings: www.energystar.gov
a. Under the Products heading, select Appliances.
b. On the Appliances page, select the appliance category you’re seeking.
1. Under Resources (right margin of page at time of print), select:
a) the interactive search link – or -- the Excel spreadsheet
2. Once you’ve found your appliance listing, print that page and attach it to your Rebate form.

Other Rebates & Incentives of Interest:
$50 High Efficiency Water Heater* Rebate:
Storage type of 50 gallons or more. 50–79 gallon H2O
heaters must have an energy factor > 0.93. H2O heaters
80 gallons and above must have an energy factor > 0.91.
$20 ENERGY STAR Compact Fluorescent Light
®
Fixture Rebate: Note: rebate is for hard-wired fixtures.
Tube type fixtures, e.g., T-8, T-12, etc. are ineligible.
$220 Shower Drainwater Heat Recovery Rebate:
Typically 80–90% of the energy used to heat household
water goes down the drain. Drain-water heat recovery
systems capture this energy to preheat cold water
entering the water heater or going to other water fixtures.
$350 - $750 Duct Sealing Incentive**
In a typical house, about 20% of the air in duct systems is lost
through leaky, poorly connected ducts. Sealing and
insulating ducts increase efficiency, lower your energy bills
(up to 20%), and can often pay for itself in energy savings.
• Jobs must meet Performance Tested Comfort System®
(PTCS™) Duct Program specifications & testing procedures.
• No pre-approval needed for manufactured homes.
$300 - $2,400 High-efficiency Heat Pump Incentive**
If you heat with electricity, a heat pump can reduce your
heating electricity use by as much as 30%–40%.
• Jobs must meet Performance Tested Comfort System®
(PTCS™) Duct Program specifications & testing procedures.
• New construction homes are eligible for this program.

$350 - $750 Duct Sealing Incentive** $6/sq. ft. Window Incentive**

In a typical house, about 20% of the air in duct systems is
lost through leaky, poorly connected ducts. A well sealed
duct system may allow you to downsize to a smaller, less
costly heating system.
Note: No pre--approval needed for manufactured homes.
Please note: restrictions apply to all Rebates & Incentives; be sure to observe all program requirements to ensure that you are eligible.
Rebates and/or Incentives may be modified or discontinued at any time.
• Original windows (includes French or sliding doors) must be
double-paned & metal framed OR single-paned.
• Garden windows are excluded from this rebate.
• Windows must be in rooms with hardwired electrical heating.
• Replacement windows may not be larger than originals.
• Windows must have U-values of 0.30 or less.
**Requires job pre-approval by PUD prior to installation.