Residential Customer Rebate Application Your browser does not have JavaScript capabilities enabled. This page (and other pages on this site) may not work as designed. It is highly recommended that you enable JavaScript and reload this page for optimum usability and experience. All required fields are marked with *This form could not be completed. Please review the highlighted messages below.Customer Information*First Name:*Last Name:Utility Account No:*Service Address:*City:*Primary Phone No.:*Email Address:*Rebate applying for:Select Type...Electric: Central Air Conditioner Tune-UpElectric: Programmable/Smart ThermostatElectric: ENERGY STAR AppliancesElectric: Electric Vehicle Level 2 ChargerElectric: Heat Pump Water HeaterElectric: Battery Powered Landscape EquipmentWater: Water Saving AppliancesElectric: Central Air Conditioner Tune-Up A spring inspection and tune-up of your central air conditioner unit can improve its efficiency and increase its life span. Without regular cleaning and maintenance, an air conditioner can lose up to 5% of its original efficiency for each year of operation. Kaukauna Utilities offers an incentive to encourage regular inspection and maintenance of central air conditioners. If you are a homeowner or business owner with a central air conditioner, you may be eligible for up to $25 toward a professional service inspection and tune-up. 12-POINT INSPECTION AND TUNE-UP 12-POINT INSPECTION AND TUNE-UP: Check and clean condensing unit coils Check wiring and connections Check coolant level Check system operating pressures and temperatures Check condensate pump and drain line Check thermostat Inspect air filter and replace if necessary Check compressor contacts Check belts and drives Clean and adjust controls Lubricate moving parts and clean indoor fan Check voltage *AC Brand Name:*Model Number:*Size (Tons):*HVAC Contractor:*12-Point Inspection Documentation:(Files accepted: PDF, JPG, PNG, GIF.)AttachmentsAttach the sales receipt or paid invoice from a professional heating and cooling inspection and tune-up service. The receipt or inspection documentation must indicate the date of service, dealer name, and an itemized list of service checkpoints, and any repair recommendations.*Sales Receipt:(Files accepted: PDF, JPG, PNG, GIF.)Certification and Agreement I agree that Kaukauna Utilities does not guarantee that the central air conditioner inspection and tune-up or the implementation of any energy efficiency described in this application will result in energy cost savings. Kaukauna Utilities makes no warranties, expressed or implied, with respect to any equipment purchased and/or installed including, but not limited to, any warranty of merchantability or fitness for purpose. In no event shall Kaukauna Utilities be liable for any incidental or consequential damages. I understand that this program has a limited budget, and that applications will be accepted on a first-come, first-served basis, until allocated funds are spent. This program may be modified or discontinued at any time without notice. I certify that all statements made in this application are correct to the best of my knowledge. I agree to the terms and conditions of this offer as set forth on this application. Rebate must be submitted within six (6) months of purchase. Rebate given in form of bill credit (*some exceptions apply). *I Agree: Electric: Programmable/Smart Thermostat We encourage the purchase of programmable smart thermostats through Focus on Energy. Focus on Energy offers instant discounts and free shipping on many popular thermostats. www.focusonenergy.com/kaukauna Purchase a WIFI smart thermostat through Focus on Energy and KU will offer an additional $25 rebate in addition to the instant discount from Focus. Purchase a WIFI smart thermostat from a source other than Focus on Energy and you may be eligible for up to a $75 rebate from Kaukauna Utilities. Thermostat Information*Thermostat Brand:*Model Number:*Cost:Attachments Original sales receipt (or a copy of the receipt). *Sales Receipt:(Files accepted: PDF, JPG, PNG, GIF.)Certification and Agreement I understand that this offer provides a bill credit rebate toward the purchase of a smart programmable thermostat (also known as a setback thermostat). The thermostat MUST be installed prior to receiving an rebate payment. The rebate payment only applies to the cost of the thermostat and does not apply to the cost of installation. This rebate is available only to customers of Kaukauna Utilities. Kaukauna Utilities does not guarantee that the purchase and installation of your programmable thermostat will result in energy cost savings. Kaukauna Utilities makes no warranties, expressed or implied, with respect to any equipment purchased and/or installed – including, but not limited to, any warranty of merchantability or fitness for purpose. In no event shall Kaukauna Utilities be liable for any incidental or consequential damages. I understand that this program has a limited budget, and that applications will be accepted on a first-come, first-served basis, until allocated funds are spent. This program may be modified or discontinued at any time without notice. I certify that all statements made in this application are correct to the best of my knowledge. I agree to the terms and conditions of this offer as set forth on this application. I agree that Kaukauna Utilities reserves the right to verify sales receipts and installation before issuing a rebate. Rebate must be submitted within six (6) months of purchase. Rebate given in form of bill credit (*some exceptions apply). *I Agree: Electric: ENERGY STAR Appliances When purchasing a new appliance, take a look at the Energy Guide to ensure the appliance has an ENERGY STAR label on the bottom right of the Guide. Limit of two appliance rebates per customer/year. *Number of appliances to submit:OneTwoAppliance 1*ENERGY STAR Product:ENERGY STAR Clothes WashersENERGY STAR Clothes DryersENERGY STAR RefrigeratorsENERGY STAR FreezersENERGY STAR DehumidifiersENERGY STAR DishwashersRoom Air Conditioners (>10 EER)*Brand:*Model #:*Receipt: (original receipt or paid invoice)(Files accepted: PDF, JPG, PNG, GIF.)*Energy Guide: (must include the ENERGY STAR logo)(Files accepted: PDF, JPG, PNG, GIF.)Appliance 2*ENERGY STAR Product:ENERGY STAR Clothes WashersENERGY STAR Clothes DryersENERGY STAR RefrigeratorsENERGY STAR FreezersENERGY STAR DehumidifiersENERGY STAR DishwashersRoom Air Conditioners (>10 EER)*Brand:*Model #:*Receipt:(original receipt or paid invoice)(Files accepted: PDF, JPG, PNG, GIF.)*Energy Guide:(must include the ENERGY STAR logo)(Files accepted: PDF, JPG, PNG, GIF.)Certification and Agreement I understand that this offer provides an incentive amount specific to the product type purchased. I agree that Kaukauna Utilities reserves the right to verify all purchases to ensure the product(s) meet(s) the ENERGY STAR program specifications. I understand that this program has a limited budget, and that applications will be accepted on a first-come, first-serve basis, until allocated funds are spent. This program may be modified or discontinued at any time without notice. I certify that all statements made in this application are correct to the best of my knowledge. I agree to the terms and conditions of this offer as set forth on this application. Rebate must be submitted within six (6) months of purchase. Rebate given in form of bill credit (*some exceptions apply). *I Agree: Electric: Electric Vehicle Level 2 Charger An Electric Vehicle Level 2 Charging Station Rebate is available; a Level 2 charging station requires a 240-volt, 30 – 50 amp dedicated outlet. A licensed electrician can tell you if your home is charging station ready. Kaukauna Utilities offers rebates if you install a Level 2 Wi-Fi enabled EV charger at your home. Rebate amount is 50% of the charger cost, including installation, up to $400. Charger Information*Charger Manufacturer:*Charger Model:*EV Charger Equipment Cost:*EV Charger Installation Costs:Vehicle Information*EV Make:*Model / Year:*Own or Lease: Own LeaseAttachmentsAttach the Receipt for the equipment and installation costs.*Receipt:(Files accepted: PDF, JPG, PNG, GIF.)Attach the charger model number and spec sheet.*Spec Sheet:(Files accepted: PDF, JPG, PNG, GIF.)Certification and Agreement I understand that this offer provides an incentive for a Level 2 EV charger at a business/residence currently receiving electricity on a retail basis from Kaukauna Utilities. Kaukauna Utilities makes no warranties, expressed or implied, with respect to any equipment purchased and/or installed including, but not limited to, any warranty of merchantability or fitness for purpose. In no event shall Kaukauna Utilities be liable for any incidental or consequential damages. I understand that this program has a limited budget, and that applications will be accepted on a first-come, first-served basis, until allocated funds are spent. This program may be modified or discontinued at any time without notice. I certify that all statements made in this application are correct to the best of my knowledge. I agree to the terms and conditions of this offer as set forth on this application. Rebate must be submitted within six (6) months of purchase. Rebate given in form of bill credit (*some exceptions apply). Rebate amount is 50% of the charger cost, including installation, up to $400. *I Agree: Heat Pump Water Heater Rebate Get a bill credit when you purchase an ENERGY STAR certified electric hybrid water heater, also known as a heat pump water heater (HPWH). ENERGY STAR qualified HPWH are 2-4 times more efficient than a conventional electric water heater. Look for the ENERGY STAR logo that may appear on the appliance, the packaging, or the EnergyGuide label. ENERGY STAR Product Information*Size of Water Heater:*Brand:*Model Number:*Install Date:*Replacing:Electric Water HeaterNatural Gas Water HeaterAttachments Attach a copy of the original sales receipt or paid invoice. IMPORTANT: The receipt or paid invoice must indicate the date of purchase, contractor name and address, brand, model number, price paid, and a copy of the Energy Guide or product manual with the ENERGY STAR logo. *Sales Receipt:(Files accepted: PDF, JPG, PNG, GIF.)Certification and Agreement I understand that this offer provides an incentive amount specific to the product type purchased. I agree that Kaukauna Utilities reserves the right to verify all purchases to ensure the product(s) meet(s) the ENERGY STAR program specifications. I understand that this program has a limited budget, and that applications will be accepted on a first-come, first-serve basis, until allocated funds are spent. This program may be modified or discontinued at any time without notice. I certify that all statements made in this application are correct to the best of my knowledge. I agree to the terms and conditions of this offer as set forth on this application. Rebate must be submitted within six (6) months of purchase. Rebate given in form of bill credit (*some exceptions apply). *I Agree: Battery Powered Landscape Equipment Rebate Make the switch and electrify your landscape equipment to help eliminate the environmental impacts from gas-powered equipment including noise pollution, air pollution and CO2 emissions. Rebates are not to exceed 10% of equipment cost. Rebates are paid as bill credit. Limit of two (2) pieces of equipment per household. *Number of pieces of equipment:OneTwoEquipment One Information*Type of Equipment:Hedge & extension trimmerLeaf blower; chain sawSingle stage snowblowerTwo stage snowblower; push lawn mowerGarden tractor mower*Manufacturer:*Model Number: Provide a copy of your proof of purchase with the name of the manufacturer and the model number. If the model number is NOT displayed on the proof of purchase, please provide a photograph of the model number of the landscape equipment purchased. *Proof of Purchase:(Files accepted: PDF, JPG, PNG, GIF.)Proof of Model Number:(Files accepted: PDF, JPG, PNG, GIF.)Equipment Two Information*Type of Equipment:Hedge & extension trimmerLeaf blower; chain sawSingle stage snowblowerTwo stage snowblower; push lawn mowerGarden tractor mower*Manufacturer:*Model Number: Provide a copy of your proof of purchase with the name of the manufacturer and the model number. If the model number is NOT displayed on the proof of purchase, please provide a photograph of the model number of the landscape equipment purchased. *Proof of Purchase:(Files accepted: PDF, JPG, PNG, GIF.)Proof of Model Number:(Files accepted: PDF, JPG, PNG, GIF.)Certification and Agreement This rebate is available only to customers of Kaukauna Utilities. Rebate is for NEW equipment only Offer valid for eligible landscape equipment from August 1, 2021 onward until further notice. Kaukauna Utilities reserves the right to modify or end this offer at any time. Kaukauna Utilities does not endorse any particular manufacturer, product, system design, or technology in promoting these rebates. Kaukauna Utilities’ liability is limited to paying the rebate specified. In no event shall Kaukauna Utilities be liable for any incidental or consequential damages. Kaukauna Utilities makes no warranties, ex- pressed or implied, with respect to any equipment purchased including, but not limited to, any warranty of merchantability or fitness for purpose. Rebate must be submitted within six (6) months of purchase. Rebate given in form of bill credit (*some exceptions apply). *I Agree: Water Saving Appliance Rebates Must be a residential KU water customer. Appliance to be used at KU water account address only. Appliance must be in new condition (not used or refurbished). Kitchen Sink Faucet: Max flow rate of 2.2 gpm or less. Bathroom Sink Faucet: WaterSense labeled. Max flow rate of 1.5 gpm or less. Showerheads: WaterSense labeled. Max flow rate of 2.0 gpm or less. Toilets: WaterSense labeled. 1.28 gpm/flush or less. Clothes washer: Tier III required, Water Factor of 6.0 or less. Dishwasher: Tier I required. Water Softener (limited time offer): Demand Initiated Regeneration (DIR) Submit application within 60 days of purchase date. To pre-qualify for the Whole Home Bonus, call (920) 462-0251 or (920) 462-0233. *Number of appliances to submit:OneTwoThreeFourFiveAppliance 1*WaterSense Product:DIR Water Softener (limited time offer)TIER III clothes washerTIER I dishwasherWaterSense toiletWaterSense lavatory faucet*Brand:*Model #:*Quantity:IMPORTANT: The receipt/paid invoice MUST include: Where purchased & Date of purchase, Brand and Model Number, Price Paid.*Receipt: (original receipt or paid invoice)(Files accepted: PDF, JPG, PNG, GIF.)*Proof of WaterSense: (must include WaterSense logo)(Files accepted: PDF, JPG, PNG, GIF.)Appliance 2*WaterSense Product:DIR Water Softener (limited time offer)TIER III clothes washerTIER I dishwasherWaterSense toiletWaterSense lavatory faucet*Brand:*Model #:*Quantity:IMPORTANT: The receipt/paid invoice MUST include: Where purchased & Date of purchase, Brand and Model Number, Price Paid.*Receipt: (original receipt or paid invoice)(Files accepted: PDF, JPG, PNG, GIF.)*Proof of WaterSense: (must include WaterSense logo)(Files accepted: PDF, JPG, PNG, GIF.)Appliance 3*WaterSense Product:DIR Water Softener (limited time offer)TIER III clothes washerTIER I dishwasherWaterSense toiletWaterSense lavatory faucet*Brand:*Model #:*Quantity:IMPORTANT: The receipt/paid invoice MUST include: Where purchased & Date of purchase, Brand and Model Number, Price Paid.*Receipt: (original receipt or paid invoice)(Files accepted: PDF, JPG, PNG, GIF.)*Proof of WaterSense: (must include WaterSense logo)(Files accepted: PDF, JPG, PNG, GIF.)Appliance 4*WaterSense Product:DIR Water Softener (limited time offer)TIER III clothes washerTIER I dishwasherWaterSense toiletWaterSense lavatory faucet*Brand:*Model #:*Quantity:IMPORTANT: The receipt/paid invoice MUST include: Where purchased & Date of purchase, Brand and Model Number, Price Paid.*Receipt: (original receipt or paid invoice)(Files accepted: PDF, JPG, PNG, GIF.)*Proof of WaterSense: (must include WaterSense logo)(Files accepted: PDF, JPG, PNG, GIF.)Appliance 5*WaterSense Product:DIR Water Softener (limited time offer)TIER III clothes washerTIER I dishwasherWaterSense toiletWaterSense lavatory faucet*Brand:*Model #:*Quantity:IMPORTANT: The receipt/paid invoice MUST include: Where purchased & Date of purchase, Brand and Model Number, Price Paid.*Receipt: (original receipt or paid invoice)(Files accepted: PDF, JPG, PNG, GIF.)*Proof of WaterSense: (must include WaterSense logo)(Files accepted: PDF, JPG, PNG, GIF.)Certification and Agreement I understand that this offer provides up to a $1,750 rebate for Kaukauna Utilities water customers who install water saving appliances. I understand that I must install water saving products throughout my home, and that I must pre-qualify my equipment prior to installation and prior to submitting this application in order to be eligible for the Whole Home Bonus. Kaukauna Utilities makes no warranties, expressed or implied, with respect to any equipment purchased and/or installed including, but not limited to, any warranty of merchantability or fitness for purpose. In no event shall Kaukauna Utilities be liable for any incidental or consequential damages. I understand that this program has a limited budget, and that applications will be accepted on a first-come, first-served basis, until allocated funds are spent. This program may be modified or discontinued at any time without notice. I understand that a Kaukauna Utilities Water Department Representative may visit my location after application is submitted to verify all installed measures. I certify that all statements made in this application are correct to the best of my knowledge. I agree to the terms and conditions of this offer as set forth on this application. *I Agree: Processing...File(s) Uploading.... Please Wait