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Residential ENERGY STAR® Appliance Rebate Form

  1. Anoka Municipal Utility (AMU) Rebates
  2. Check this box to acknowledge that you have read and agree to our rebate policy Rules & Requirements.*
  3. Submitting this document electronically will require you to upload documentation such as sales receipt, etc.  Please do not send sensitive information.

  4. Select Qualifying Purchase Date:*

    Customers must apply for rebates within twelve (12) months of the purchase date shown on the sales receipt.

  5. Anoka Municipal Utility (AMU) Customer Information

    You must have an address that is serviced by Anoka Municipal Utility (AMU). 

  6. Anoka Municipal Utility (AMU) is my electric service provider.*
  7. Rebate amount will be credited to your AMU billing account. No need for a mailing address. This must be the location of installation for the rebate. 

  8. Building Type*
  9. Retailer Information
  10. Receipt(s) submitted must include Retailer Information and Purchase date along with product information for proof of purchase.

    Take a picture from your phone, a screen shot, or scanned copy of original receipt. 

  11. Equipment Information
  12. Select the appliance type for rebate*

    Limit one of each type per account per calendar year. 

  13. Select One*
  14. Is your appliance ENERGY STAR®*
  15. Unit Size
  16. Water Heating Element
  17. Type of Dryer Used in home
  18. Replacement Appliance?
  19. How old was the model it replaced?

    Estimate if unsure.

  20. Old Appliance Status
  21. Recycled Old Appliance?*

    Refrigerators/Freezers may receive an additional $50.00 rebate for a Recycled Appliance. 
    Notice: AMU reserves the right to verify recycling drop-offs and pick-ups from the reported address indicated on this form.

  22. Hauler or Retailer Name that appliance was picked up on behalf of, or dropped off at.

  23. Certification of De-Manufacturing*

    By checking this box, I certify this appliance has or will be turned over to a licensed recycler and removed from the grid (not resold or reused). To the best of my knowledge the appliance will be fully decommissioned including refrigeration and mercury components and refrigerants and CFC’s recycled following federal, state and local laws. I attest the following information is accurate and true and that this appliance was or will be turned in by the date above, and verified by the applicant listed on this rebate form.

  24. Disclaimer & Signature
  25. Check this box to agree to the following:*
  26. Electronic Signature Agreement*
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
  27. Leave This Blank:

  28. This field is not part of the form submission.