"*" indicates required fields CommentsThis field is for validation purposes and should be left unchanged.Homeowner Name* First Last Installation Address* Street Address Address Line 2 City ZIP Code Mailing Address Same as installation address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone*Email* Purchase Date* Month Day Year Appliance Purchased*Home must have an electric water heater and the dryer must be electric in order to qualify for the rebate. Clothes washer must be front load. All appliances must be Energy Star certified. Clothes Washer Clothes Dryer Clothes Washer Model Number*Clothes Dryer Model Number*Upload Receipt Here*A copy of the receipt must accompany this application. Drop files here or Select files Max. file size: 100 MB. DisclaimerRebate amounts and program requirements are subject to change or be discontinued at any time by Central Electric Cooperative (CEC). CEC disclaims any warranty, whether expressed or implied, regarding the products listed above for any materials or labor associated with installation, maintenance, repair, or any energy savings associated with use. All homes are subject to inspection & usage data analyzed by participating in energy efficiency programs by CEC or partnering third parties. Products and installation must meet all program criteria to qualify for rebates. I understand the above and certify that I am a member of CEC, that the products are installed and operating at the location indicated and that this address is electrically served by CEC. Rebates $250 and under will be credited to a member’s bill.Digital Signature*By checking this box and typing my name, I certify that all information on this form is true and correct. I also agree that the checkbox and my name typed below are to be used as my electronic signature. I understand that I can be held liable if I provide false or misleading information. I certify the above information is true and correct and I am the person submitting this form. Type Full Name*Consent* I agree to the CEC Privacy Policy.
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