ORCAS POWER AND LIGHT COOPERATIVE

NEEM / Energy Star®

MANUFACTURED HOMES PROGRAM
$850.00 - REBATE COUPON
♦ Rebate available until 3/31/10

Name:
Mailing Address:
Installation Address:
Phone #:
Make:
Model #
Where Purchased:
Date of Purchase:
NEEM Certification #:
HUD #’s ________________________________ ______________________________________

I certify that this manufactured home was purchased for installation at the above stated address. I will allow a
representative of Orcas Power and Light Cooperative and /or Bonneville Power Administration to verify that
the home meets required Energy Star NW Homes specifications. I understand that there must be an electric
water heater and electric heat installed in the home to qualify for this rebate.

Homeowner signature _______________________________ ___ Date _______ ______

Please attach a copy of sales receipt or contractor’s itemized billing

For OPALCO use only

To be completed by OPALCO Energy Services Department:
Inspection Completed By: Inspection Date:

Rebate Amount $

To Accounting for Check: Date: _________________ Initials: __________________

Ledger Account # 908.7

Revised 2/10