ENERGY STAR APPLIANCE & PRODUCT Rebate Application

1 ENERGY STAR APPLIANCE & PRODUCT . Rebate Application Application must be submitted within 90 days of purchase date or by December 31, 2021, whichever comes first. Visit to apply online. HOW TO APPLY. 1 VERIF Y ELIGIBILIT Y. You must be a current Ameren Illinois electric or gas residential delivery service customer. APPLIANCE must be ENERGY STAR certified. A list of qualifying ENERGY STAR certified models can be found at 2 COMPLETE Application . Check your Application to ensure it is correct, legible, complete and signed before submitting.

2 If you are applying for two rebates, submit an additional copy. 3 SUBMIT Application . To process your Rebate , you must provide information about your heating and cooling system, and a copy of the sales receipt or invoice clearly identifying the PRODUCT /model, date, place of purchase, and price of purchase. If it's a contractor invoice, please make sure the price of the APPLIANCE is itemized (excluding taxes, shipping and installation charges). For a smart thermostat, you must provide the thermostat's serial number. For gas clothes washers, you must have an Ameren Illinois gas account.

3 All other rebates require that you have an Ameren Illinois electric account. For a pool pump, the pump must be a new installation or replacement of an existing single-speed pool pump. Limit of 1 pool pump Rebate per account. Equipment must be an ENERGY STAR variable-speed pool pump to be eligible. Rebate does not apply to single-speed, two-speed or multi-speed pool pumps . Application must be completed and signed by the customer with the Ameren Illinois account at the installation address. Please check your most recent Ameren Illinois bill to confirm who is listed as the account holder.

4 Q U E S T I O N S ? C A L L 1. 8 7 7. 4 7 5 . 4 2 7 0. y CONTINUE ON PAGE 2. ENERGY STAR APPLIANCE & PRODUCT . Rebate Application SECTION 1: CUSTOMER INFORMATION. Account Holder Name: Home Phone (include area code): Cell Phone (include area code): Installation Address: City: State: ZIP Code: Mailing Address: City: State: ZIP Code: Email: How did you learn about this Rebate ? Email Utility Bill Communications Digital Ad Event Newsletter Print Ad In-store Ad Other Please Specify:_____. ENERGY Delivery Information - Account Number A.

5 Meren Illinois A. meren Illinois . GAS Customer (Max. 5 digits per box. Ex.: 12345 - 67890) ELECTRIC Customer (Max. 5 digits per box. Ex.: 12345 - 67890). SECTION 2: Rebate PAYMENT AUTHORIZATION. Make check payable to (check ONE): Account Holder Landlord Mailing Address: City: State: ZIP Code: (IF LANDLORD) Landlord Name: Phone (include area code): Email: Customer Authorization (required if Rebate check is made payable to the landlord noted above). I am authorizing the payment of the Rebate to the third party named above and I understand that I will not receive the Rebate payment from Ameren Illinois.

6 I also understand that my release of the payment to a third party does not exempt me from the eligibility requirements outlined in this Application and agree to abide by these requirements. Ameren Illinois Customer Signature: Print Name: Date: y CONTINUE ON PAGE 3 2. ENERGY STAR APPLIANCE & PRODUCT . Rebate Application SECTION 3: ENERGY STAR CERTIFIED APPLIANCE (CHECK ONE PER Application ). ENERGY STAR Smart Thermostat $100 ENERGY STAR Freezer $50 ( cubic feet). ENERGY STAR Refrigerator $50 ( cubic feet) ENERGY STAR Electric Dryer $50 ( cubic feet).

7 ENERGY STAR Clothes Washer $50 ENERGY STAR In-Ground Pool Pump $275 (variable speed). ENERGY STAR heat Pump Water Heater $300 ENERGY STAR Window or Wall Air Conditioner $25. Self-installed Contractor-installed Each qualifying residential customer account is limited to one Rebate per APPLIANCE . Make: Model Number: Purchase Price: (excluding taxes, shipping, and installation charges) Purchase Date: (MM/DD/YYYY) Install Date: (MM/DD/YYYY). Retailer Name: Retailer City: Retailer State: Retailer ZIP Code: Serial Number: Primary Heating Fuel: Heating: Gas Electric Furnace Boiler Baseboard Air Source heat Pump Ground Source heat Pump Ductless Mini-Split heat Pump Other: _____.

8 Cooling Systems (quantity of each unit): Central AC ____ Air Source heat Pump ____ Ground Source heat Pump ____ Ductless Mini-Split heat Pump ____ Other:_____. Please answer the following if filing for a clothes washer or electric dryer Rebate : 1. What fuel type does your clothes washer use? 2. What fuel type heats your water heater? Electric Electric Natural Gas (does not include propane) Natural Gas (does not include propane). Unknown (including Propane) Unknown (including Propane). SECTION 4: CUSTOMER SIGNATURE (REQUIRED).

9 I certify that the information provided in this Application is true and correct. I have read and understand the Rebate eligibility requirements set forth in this Application and agree to abide by these requirements. I also agree that by receiving a Rebate , I may be contacted by an evaluator to complete a customer survey. Customer Signature: Printed Name: Date: Submit the mandatory materials to receive your Rebate : Submit this Application by mail to: Completed Rebate Application Ameren Illinois Rebates 3100 West Rd, Bldg 3 Suite 200.

10 Legible copy of the entire sales receipt East Lansing, MI 48823. y CONTINUE ON PAGE 4 3. ENERGY STAR APPLIANCE & PRODUCT . Rebate Application AMEREN ILLINOIS RESIDENTIAL ENERGY EFFICIENCY PROGRAM TERMS AND CONDITIONS. 1. Definitions In addition to terms defined elsewhere herein, when any one of the following terms is used in these Terms and Conditions, wherein the first letter is written with a capital letter, then that term shall have the following definition. Words importing persons include corporation, and words importing only the singular include the plural and vice versa when the context requires.