Rebate Application Form - City of Seguin

Energy Efficiency
Appliance Rebate Application
Date:______________________ Time:__________________ _
Name: _______________________________________________
___________________________________
Address: ____________________________________ ___________________ ________________________
Account #: ____________________ _______________________ __________________________________
Email (optional): ______________________________ ______________ ____ ______________________
Phone Number: _______________ _ __________ Other Number (optional):____ _______ ______________
Please check the below appliance(s) you are requesting a rebate on:
Washer ~ $100
Dishwasher ~ $50
Window A/C unit~$50
Refrigerator ~ $100
Get a rebate when you recycle your old appliance and replace it with a new Energy Star
Rated Model.
The City of Seguin requires a signed document showing the old appliance was hauled
away at the time of delivery.
The City also requires the purchase to be made locally in Seguin.
The appliance rebates will be approved as long as funding allows and the rebates will be
given out on a first come first serve basis, based upon the date and time of this
application.
You must be a City of Seguin Electric Customer in order to take advantage of the Residential
rebate, which will be subject to inspection and verification by an authorized representative of
the City of Seguin Utility Services Department, to determine it has been installed within the
home of a City of Seguin Electric Customer and purchased locally.
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City of Seguin
Energy Efficient Appliance Rebate Application Continued
I have read, understand and agree to the following program guidelines:
I am a City of Seguin single-family electric utility customer with an account in good
standing.
Prior to issuance of credit to your account, a site inspection will be conducted to verify
product installation. Products must be installed and functional at the time of the
inspection.
The purchased appliance has to be Energy Star compliant. The City of Seguin does not
endorse specific brands, products or dealers; nor does it guarantee materials,
workmanship, performance or durability of qualifying products.
The Customer will have Sixty (60) days from the date of approval to purchase a compliant
appliance. The appliance must be purchased from a participating local vendor. (Make Sure
You Keep The Receipt).
Applicant Signature: ______________________________________________________Date: ___________
If you have any questions regarding the application or inspection process please contact and
send the completed application to:
Clay Howard
Utility Services Superintendent
City of Seguin
Utility Services
816 Fred Byrd
Seguin, Texas 78155
choward@seguintexas.gov
Phone (830) 401-2404
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