Ledfixture Rewardform

$30 Cash-Back Reward
per select ENERGY STAR® qualified LED fixture

Expires 12/31/10. Reward on select ENERGY STAR® qualified LED fixtures. Limit 12 per customer. Valid for Wisconsin
residential customers of participating utilities only. Customers of some Wisconsin municipal and cooperative
utilities may not be eligible. See salesperson or call 800.762.7077 for details.
PLEASE COMPLETE THE INFORMATION BELOW
My Electric Utility Company is Customer Name
Street Address City State ZIP
Daytime Phone (for verification only) Email Address
Name of Store Where Purchased City State
Why did you purchase this/these fixture(s)? Have you purchased ENERGY STAR qualified fixtures before?
long bulb life energy savings Cash-Back Reward other reasons Yes No
Check the one box that best represents where fixture(s) will be used:
farm business single family home (1-3 units) apartment/condo building (4 or more units)
PLEASE ENTER QUANTITY BEING PURCHASED

Quantity Manufacturer Model Number Trim Requirements*
Cree Lighting LED LR6 N/A
Cree Lighting LED LR6-GU24 N/A
Cree Lighting LED LR6C N/A
Cree Lighting LED LR6C-GU24 N/A
Cooper Lighting Halo LED ML706830 494WB06, 494H06, 494SC06, 494P06
205W-WH, 205B-WH,205B-SC, 205B-ABZ, 204C-WH, 204G-WH,204B-WH,
Juno recessed can LED fixtures IC20LED-35K
204PT-WH, 204W-WH, 204HZ-WH, 204WHZ-WH, 204WHZ-ABZ
205W-WH, 205B-WH, 205B-SC, 205B-ABZ, 204C-WH, 204G-WH, 204B-WH,
Juno recessed can LED fixtures IC20RLED-35K
24W-WH, 24B-WH 24B-SC, 24B-ABZ, 24B-BL, 27C-WH, 27G-WH, 27B-WH,
27PT-SC, 27W-WH, 27HZ-WH, 27WHZ-WH, 27WHZ-ABZ
24W-WH, 24B-WH, 24B-SC, 24B-ABZ, 24B-BL, 27C-WH, 27G-WH, 27B-WH,
24W-WH, 24B-WH 24B-SC, 24B-ABZ, 24B-BL, 27C-WH, 27G-WH, 27B-WH,
24W-WH, 24B-WH, 24B-SC, 24B-ABZ, 24B-BL, 27C-WH, 27G-WH, 27B-WH,
Philips Solid-State eW Downlight
Must be paired with 120V Ballast Module part number 523-000010-00.
Lighting Solutions, Inc. Powercore 65˚ 2700K
TOTAL purchased x $30 = TOTAL REWARD (Limit 12 per customer)
Please see reverse side for details on how to receive your Cash-Back Reward.
*Must be used with one of the trims noted to maintain ENERGY STAR qualification.
Mail to: Focus ENERGY STAR Lighting, c/o EFI Fulfillment Center,
40 Washington Street, Suite 2000. Westborough, MA 01581-1013
$30 Cash-Back Reward
per select ENERGY STAR® qualified LED fixture
To receive your Cash-Back Reward:

1. Purchase the ENERGY STAR qualified product(s), including trim requirements if noted, of your choice.
2. Cut out the UPC code and ENERGY STAR logo (see above left corner for example), if available, from each package and attach it to this completed form along
with a copy of the cash register receipt with the purchase price(s) circled. If the UPC code and logo are not available, please attach an itemized receipt.
Mail to: Focus ENERGY STAR Lighting, c/o EFI Fulfillment Center, 40 Washington Street, Suite 2000. Westborough, MA 01581-1013
Important Information:
This offer valid only to Wisconsin residential customers of participating electric utilities, and for a limited time. Customers of some Wisconsin
municipal and cooperative utilities may not be eligible. Offer is good while supplies last, and may not be combined with any other Wisconsin Focus on
EnergySM offer. Offer expires 12/31/10. Limit 12 per customer. Offer valid on select ENERGY STAR qualified LED fixtures. Redeemable by mail only. Focus
on Energy reserves the right to withdraw or change this offer without notice. Photocopies or facsimiles of this form are not acceptable. Cash-Back
Rewards may not exceed purchase price.
The final price paid by the consumer after the mail-in Reward is received must be at least $0.97 per fixture. Products purchased for less than $0.97
each after mail-in Reward (not including tax), will not receive the full $30 Cash-Back Reward. Wisconsin Focus on Energy reserves the right to withdraw
or change this offer without notice. Photocopies or facsimiles of this form are not acceptable. Cash-Back Rewards may not exceed purchase price.
Rebated fixture may not be used for resale. Ineligible rebates are subject to denial or repayment to program. Cash-Back Reward requests must be
postmarked by 1/15/11.
Call 800.762.7077 to find out more about how you can save energy.
Confidentiality Statement:
I am providing the requested information solely to be eligible to participate in this program and request that the personal information supplied by me
be treated as confidential to the maximum extent possible.
___________________________________________________________
Sign or Initial here
To be eligibile for the $30 Cash-Back Reward, you must purchase your electricity from one of the folowing electricity providers:
Adams-Columbia Electric Cooperative Elroy Electric & Water Utility North Central Power Co. Inc. Sun Prairie Water & Light
Algoma Utilities Evansville Water & Light Northwestern Wisconsin Electric Company Superior Water, Light & Power
Alliant Energy Fennimore Municipal Utility Oakdale Electric Cooperative Two Rivers Water & Light
Arcadia Electric Utility Florence Utilities Oconomowoc Utilities Vernon Electric Cooperative
Argyle Electric & Water Utility Gresham Water & Electric Plant Oconto Electric Cooperative Viola Municipal Electric Utility
Bangor Municipal Utility Hartford Electric Oconto Falls Municipal Utilities Waterloo Utilities
Barron Light & Water Hazel Green Light & Water Utility Pardeeville Public Utilities Waunakee Utilities
Belmont Municipal Light & Water Hustisford Utilities Pierce Pepin Cooperative Services Waupun Utilities
Benton Electric & Water Utility Jefferson Utilities Pioneer Power & Light Co. We Energies
Black River Falls Municipal Utilities Juneau Utilities Plymouth Utilities Westby Utilities
Bloomer Electric & Water Utility Kaukauna Utilities Prairie du Sac Utilities Westfield Electric Company
Boscobel Utilities Kiel Utilities Price Electric Cooperative Whitehall Electric Utility
Brodhead Water & Light La Farge Municipal Utilities Princeton Light & Water Department Wisconsin Dells Water & Light Utility
Cadott Light & Water Department Lake Mills Light & Water Reedsburg Utility Commission Wisconsin Public Service Corp.
Cashton Light & Water Lodi Utilities Rice Lake Utilities Wisconsin Rapids
Cedarburg Light & Water Madison Gas & Electric City Utilities of Richland Center Water Works & Lighting Comm.
Centuria Municipal Electric Utility Manitowoc Public Utilities Richland Electric Cooperative Wonewoc Water & Light Department
Clark Electric Cooperative Marshfield Utilities River Falls Municipal Utilities Xcel Energy
Clintonville Utilities Mazomanie Electric Utility Rock Energy Cooperative
Columbus Water & Light Medford Electric Utility Sauk City Utilities
Consolidated Water Power Company Menasha Utilities Scenic Rivers Energy Cooperative
Cornell Municipal Light Department Mount Horeb Utilities Shawano Municipal Utilities
Cuba City Light & Water Muscoda Utilities Shullsburg Electric Utility
Cumberland Municipal Utility New Glarus Light & Water Slinger Utilities
Dahlberg Light & Power Company New Holstein Utilities Spooner Municipal Electric Utility
Eagle River Light & Water Utility New Lisbon Municipal Light & Water Stoughton Utilities
Eau Claire Energy Cooperative New London Utilities Stratford Water & Electric Department
Elkhorn Light & Water New Richmond Utilities Sturgeon Bay Utilities
Focus on Energy works with eligible Wisconsin residents and businesses to install cost effective energy efficiency and renewable
energy projects. Focus information, resources and financial incentives help to implement projects that otherwise would not be
completed, or to complete projects sooner than scheduled. Its efforts help Wisconsin residents and businesses manage rising
energy costs, promote in-state economic development, protect our environment and control the state’s growing demand for
electricity and natural gas. For more information, call 800.762.7077 or visit focusonenergy.com.
© 2009 Wisconsin Focus on Energy RES-6041-0809

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Ledfixture Rewardform

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Copyright:

Available Formats

$30 Cash-Back Reward

per select ENERGY STAR® qualified LED fixture

Street Address City State ZIP

Daytime Phone (for verification only) Email Address

Name of Store Where Purchased City State

PLEASE ENTER QUANTITY BEING PURCHASED

TOTAL purchased x $30 = TOTAL REWARD (Limit 12 per customer)

To receive your Cash-Back Reward:

© 2009 Wisconsin Focus on Energy RES-6041-0809

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