STEP 1 – Complete sections A, B, & C.

A. Applicant Information (Applicant must be an Alger Delta member in good standing)
Name (print): _________________________________________________________________
Address: ____________________________________________________________________
Alger Delta Account #: _________________________________________________________
Applicant Signature: ___________________________________________________________

B. Type of ENERGY STAR Rated Appliance Only ENERGY STAR rated appliances are eligible. The rebate amount is indicated for each type of appliance. Rebates shall be provided to the member of record for the account listed hereon.

Clothes Washer ($100) Refrigerator/Freezer ($100) Dish Washer ($50) Window Air Conditioner ($50) Dehumidifier ($50)

C. Vendor Information

Store Name: _____________________ Address: ____________________________________
Phone: ________________________________

STEP 2 – Obtain vendor certification (Only purchases made between 07/11/2009 – 09/30/2009 are eligible for rebate).

I certify that the appliance(s) purchased is/are ENERGY STAR rated. Certified by: ________________________________________ Date: ______________________ Appliance manufacturer/model: ____________________________________________________ Appliance purchase price (before rebate and taxes): $_________________________________

STEP 3 – Submit completed application form and copy of receipt to: Alger Delta Appliance Rebate – 426 N. 9th St – Gladstone, MI 49837. Fax to 906-428-3840.

Member approved to receive the rebate indicated above. Approved by: _________________________________ Date: ________________

Disclaimer: This program is the result of grant funds available from WPPI Energy. This program shall begin on July 11, 2009 and shall end on September 30, 2009 or until funds are exhausted, whichever occurs first. Only appliances purchased during the effective dates of this program shall qualify. Alger Delta is not responsible to provide a rebate if program funds are exhausted or otherwise unavailable for any reason. Alger Delta makes no warranty, express or implied, and is not responsible for the operation or performance or energy consumption of any appliance(s) purchased under the terms and conditions of this program. Alger Delta is not responsible for appliance delivery or removal.

Allow 4-6 weeks for processing of rebates.