Energize Missouri Appliance Rebate Program

Retailer or Installation Contractor Information

Retailer or Installation Contractor*:
Web Site:
Location Address*:
Address 2:
City*:
State*:
ZIP*:

Check all ENERGY STAR^® appliances sold in store:
Air Source Heat PumpsGas FurnacesCentral Air Conditioning Water Heaters - Electric Heat PumpWater Heaters - Hi-Eff Gas StorageWater Heaters - Gas Tankless Water Heaters - SolarClothes WashersDishwashers

Retailer or Installation Contractor Point of Contact

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Participant Expectations

Participating retailers or installation contractors must agree to comply with all of the following conditions at all storefront locations. All boxes must be checked to participate with the Energize Missouri Appliance Rebate Program:

In Store		Reserves rebates for consumers via the site http://Retail.MissouriApplianceRebate.com or by calling 1-877-233-1682. This process includes verifying the consumer is a resident of Missouri, is 18 years of age or older, is purchasing an approved ENERGY STAR appliance, and is the owner of the appliance being replaced.
		Provide consumers with mail-in rebate application form.
		Promote the program to consumers via in-store signage, flyers, advertisements.
		Display a printed, legible copy of the current list of United States Department of Energy (DOE) approved ENERGY STAR appliances eligible for rebates which are sold in your store.
		Properly identify, with a visible marker, showroom appliances that are eligible for a rebate, including the rebate value.
		Provide consumers the original sales receipts as proof of purchase.
Marketing and Outreach		Use suggested marketing materials available on this site, http://Retail.MissouriApplianceRebate.com.
		Provide consumers options and information for recycling services of replaced appliances.
Recycling		If offering a recycling program, 100 percent of those appliances replaced as part of the Energize Missouri Appliance Rebate Program must be properly recycled. Old appliances must be de-manufactured so they are rendered permanently inoperable and processed through a recycling facility. All hazardous materials are handled in accordance with federal, state, and local laws. All recyclable material must be sorted and reprocessed into raw materials for future use. The consumer must be provided a signed receipt verifying the replaced appliance has been received by the retailer and will be properly recycled.
Reporting		Report to the contractor any in-kind service contributions. Reports must be submitted within five business days after each calendar quarter. No report is required if contributions are $0. Click here to view an example of an in-kind contribution report.
		Agree to future on-site verification of program compliance.

** Approved appliances may be found at www.energystar.gov

Authorization

I certify that I am an officer or employee of the identified retailer or installation contractor with the title set forth below, and I am authorized to bind the retailer or installation contractor to the terms of this Agreement. The information provided in this Agreement is accurate and complete.
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Retailer or Installation Contractor Point of Contact

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Participant Expectations

Authorization