4/16/2019 New Hampshire Saves Rebate Form

APPLICANT INFORMATION

Please note elds with * are required elds

Applicant First Name* Richard

Applicant Last Name * zecchino

Mailing Address * 76 Brown Ridge Rd Weare N

City* weare

State * NH
ZIP Code * 03281
Home Phone 6038091594
Work Phone

Email Address * zecchino@gmail.com

ACCOUNT INFORMATION

Name and address on utility bill matches above

Account Holder First Name* Marianne
Account Holder Last Name * Rousseau
Company Name:

Installation / Service Address: 76 brown ridge rd

*
weare
City* weare

State * NH

ZIP Code * 03281

*
Electric Service Provider Eversource

Electric Account Number * 56175780048

PRODUCTS PURCHASED

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4/16/2019 New Hampshire Saves Rebate Form

I would like to apply for the Dehumidi er ($25)

following rebate
Limit 2 (per residential electric customer account, per year)
Manufacturer* Toshiba

Model Number * TDDP7011ES2

Purchase Date 4/8/2019

Purchase Price $ 199

Why did you purchase a dehumidi er at this time? *

Old machine broke Wanted upgrade
New Home Energy Savings
Remodeling New purchase

What was the main reason Energy Savings

you purchased a select
ENERGY STAR certi ed
dehumidi er? Select one

Did you know about this No

rebate before you purchased
your dehumidi er?

If so, did the rebate in uence No

your purchase decision?

How did you hear about ENERGY STAR certi ed clothes washers?
Insert in your utility bill Web site
Retailer/salesperson Other

GENERAL SURVEY QUESTIONS

House Information Own

(Own/Rent) *
House Information Primary Residence
(Residence) *
House Information (Building Single-Family
Type) *

SUPPORTING DOCUMENTS

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4/16/2019 New Hampshire Saves Rebate Form
Uploaded Files Please attach digital images of the supporting
1. IMG_20190416_0001.pdf documents listed below using the Upload File /
Browse button to the left. Attached images should
Upload File Choose File No file chosen
be in JPG, GIF, PNG, BMP, TIF, DOCX or PDF
format, and should be no larger than 3 MB.
Submitting images of multiple documents in one
image is allowed. Please check your attachments
for legibility prior to uploading - illegible
supporting docs will need to be re-submitted, and
will delay processing your rebate.
Copy of dated sales receipt/invoice showing
Manufacturer, Model #, price & date of
purchase for the dehumidi er.
A copy of recent electric bill

SUBMISSION

I agree to the Terms and Conditions set forth by NHSaves & Energy Federation, Inc.

By checking the box above, I hereby certify that I purchased the ENERGY STAR® certi ed product(s) noted on the
rebate form for the installation address noted, and I am a residential customer of a participating NHSaves utility.
I have read and agree to the eligibility information provided.

CONFIRMATION

A con rmation email has been sent to your email address.

Reference #: 2599540

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