Public Works Department
P. O. Box 1614, 21 Reeve Street
Woodstock, Ontario, N4S 7Y3
Phone: 519-539-9800  Fax: 519-421-4711
Web site: www.oxfordcounty.ca
Application Form
Oxford County Washing Machine Rebate
Replace your old, top-loading washing machine with a new ENERGY STAR® model and receive a $100
rebate from the County of Oxford.
Your rebate cheque will be mailed to you based on the information you provide below within 10 weeks.
A limited number of rebates are available for the program and will be awarded on a first come first served
basis. One rebate per single family residential customer and for each owner of a multi-residential building
with 6 or less residential units. Rebates are only available to Oxford County residents that are
connected to a municipal water system.
Applicant Information
(Please print clearly)
Name:
Phone:
Address:
Postal Code:
Email:
Washer Brand Name:
Purchase Date:
Model #:
Water/ Hydro Account #:
The personal information on this form is collected pursuant to the Municipal Act, 2001 and in accordance with the
Municipal Freedom of Information and Protection of Privacy Act. This information will be used for the purposes of
administration of the Water Efficiency Program.
I have read, understand and agree to the terms and conditions of the Oxford County Washing Machine Rebate
Program and have initialed the backside of this page. I certify that I have replaced a traditional top-loading washing
machine with an ENERGY STAR® qualified model.
Signature:
Date:
Complete this application form and mail it, along with your original, dated sales receipt and a special receipt from the
Oxford County Waste Management Facility or other acceptable written proof of disposal of your old washing
machine, to:
Oxford County
Public Works Department
P. O. Box 1614, 21 Reeve Street
Woodstock, Ontario, N4S 7Y3
For more information and a list of qualified
washing machines, visit:
www.oxfordcounty.ca/rebate
Terms and Conditions
Oxford County Washing Machine Rebate
Oxford County Water Efficiency Administration
1. The Oxford County Washing Machine Rebate and all portions thereof (“the Program”) will be administered by the
Public Works Department of the County of Oxford (“the County”)
Eligibility
2. To be eligible for participation in the Program, the Applicant must:
a. Be living in a single family residential unit or be an owner of a multi-residential building with 6 or less residential units;
b. Be connected to a municipal water supply within Oxford County and have a water account in good standing (no arrears);
c. submit the completed application form and initialled the Terms and Conditions as required for the Program.
Proof of Compliance and Conditions for Payment
3. Payment of rebate will be conditional on:
a. Submission of a complete application verifying installation of an ENERGY STAR® washing machine as identified by the
Applicant on the application form, and the associated original, unaltered, and dated sales receipt (original receipt will be
returned);
b. That the washing machine being rebated under the Program is replacing an existing top loading machine that is being taken
out of service;
c. Requesting a special receipt when disposing of the old washing machine at the Oxford County Waste Management Facility or
obtaining other acceptable written proof of disposal and submission;
d. The Applicant providing access to the County to the facilities where the washing machine is installed for the purposes of
verifying the completed installation of the washing machine and/or reading the water meter.
4. The County reserves the right to accept or reject, at its sole discretion, any application or any part thereof.
5. As County funding and/or resources are limited, applications will be acted upon in a first-come-first-served basis.
General Conditions
6. At any time and for any reason, the County may refuse any or all further applications for the Program, may extend the
deadline for applications for the Program or any other deadline, or may terminate the Program, all in the County’s sole
discretion.
7. The Applicant shall ensure at all times that any and all Federal, Provincial, and Municipal laws and by-laws are adhered to.
8. The County shall be entitled to use any information, photographs, and other data concerning a selected facility in any report
and or promotional materials produced by and/or for the County.
Applicant’s Responsibility
9. Each participating Applicant must assume all financial and other responsibility in relation to the application and participation
in the Program including but not limited to:
a. The purchase and installation of the new washing machine, including any preparatory and repair work that is required for
the proper installation of the new washing machine; and
b. any costs associated with the installation of the new washing machine; and
c. acquiring any permits and or selecting and using properly licensed installers, if so required.
Disclaimer and Release
10. The Applicant hereby releases and forever discharges the County and its officers, employees, agents and elected officials
(the “Releasees”) from and against any and all claims, costs or demands whatsoever, that it may now or ever have against the
Releasees in relation to any loss, damage or injury (including death) that may occur indirectly, directly, or consequently as a
result of or arising from the Applicant’s participation in the Program, including but not limited to the work or activities in
relation hereto.
Applicant’s Initials: