P.O.

Box 127 16755 Finley Butte Rd La Pine, Oregon 97739

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

$50 Electric Water Heater Rebate

Water Heater must be purchased after 10/01/06

Send Rebate Check To:

Name:
Address:
Phone No:

Water Heater Installed At:

Name:
Address:
Phone No:

Water Heater Information:

Brand Name: Purchased At:

Model No: Energy Factor Rating:
Warranty: years

Energy Factor (EF) must be .93 or higher for 50 to 59 gallons. EF must be .91 or higher for 60 gallons or more.

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

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.