Town of Sharon Rebate Application Form
Water-Efficient Clothes Washer
Revised March 2014
Application Date: _____________________
Customer Name: __________________________________________________________
Installation Address: _______________________________________________________
Mailing Address: __________________________________________________________
Telephone & Email: ________________________________________________________
Brand: ___________________________________________________________________
Model Number: ___________________________________________________________
Energy Star Water Factor: _____________________
Date of Purchase: _____________________
Date of Installation: _____________________
Type of Washer Replaced:
□ Top Load
□ Front Load
Estimated Age of Washer Replaced: _____________________
I have read the Rebate Conditions and Guidelines (see back of this sheet). I understand and
agree to these Conditions and Guidelines.
Applicant Signature
Date
OFFICE USE ONLY
□ Approved; □ Denied
Authorized by: _______________________
Account # ___________________________
Total Rebate Amount: _________________
Rebate Issue Date: ____________________
Town of Sharon
Water-Efficient Clothes Washer Rebate Program
Conditions and Guidelines
A rebate of up to $200 is offered for the purchase of a high efficiency clothes washer. It takes 4-5
weeks after application to process a rebate check.
The washer must have a “water factor” of 4.0 or less as shown on the Energy Star clothes
washer list at www.energystar.gov. Not all Energy Star washers qualify! Water factor is the
number of gallons of water used per cubic foot of laundry capacity.
A copy of your receipt must accompany the rebate application and if purchased by credit card, a
copy of your credit card statement is also required.
All clothes washer rebate applications must be made within 90 days of purchase.
One washer rebate per household.
The applicant must be a residential water customer of record for an active, non-delinquent
account. The washer must be installed at the property where the water is delivered.
Clothes washer rebates are subject to availability of funds on a first come, first served basis and
the Town reserves the right to amend and/or discontinue this program without notice.
Only new washing machines, purchased for personal use and not for resale are eligible.
The property owner is solely responsible for ensuring proper installation. Proper disposal of the
old machine is the responsibility of the property owner. Old machines may not be reused.
The Town reserves the right to perform a site visit to verify installation prior to or following
issuance of a rebate.
The Town is not responsible for washer performance or estimated savings, and does not provide
any warranties or guarantees, express or implied.
Offer does not apply to new construction.