16755 Finley Butte Rd / P.O.

Box 127 La Pine, Oregon 97739

(541) 536-2126 (800) 722-7219 FAX (541) 536-1423
www.midstateelectric.coop

$70 ENERGY STAR ® Washing Machine Rebate

Washing Machine must be purchased after 10/01/06

Send Rebate Check To:

Name:
Address:
Phone No:

Washing Machine Installed At:

Name:
Address:
Phone No:

Washing Machine Information:

Brand Name: Purchased At:

Model No:

Modified Energy Factor (MEF) must be 1.72 or higher and include a maximum Water Factor (WF) of 8.0

Water Heater Type: ___Gas ___Electric ___Propane

I certify that this washing machine was purchased for installation at the above address. If requested, I agree to allow a
Midstate Electric representative to verify the installation of the washing machine.

Buyer Signature:

Member Account No: Date:

Midstate Representative Signature: Date:

NOTE: Your purchase receipt must accompany this rebate form

and you must be a member of Midstate Electric Cooperative.