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2. Custom Commercial Rebate Application

   The business must have an address that is serviced by Anoka Municipal Utility (AMU). This also must be the location where the cooling unit is installed for a rebate.

3. 
5. Check this box to acknowledge that you have read and agree to our Rebate Policy.*

   1. Yes
6. Rebate Policy
   Program Specific Rules and Application Process

   Check out the Rules and Application Process before filling out the form.

8. Select Qualifying Purchase Date:*

   1. Receipt dated within last 12 months
   2. Receipt older than 12 months from current date. (Sorry does not qualify)

   Customers must apply for rebates within twelve (12) months of the purchase date shown on the sales receipt.

10. Anoka Municipal Utility (AMU) Customer Information
12. Business Name*
14. Contact Name*
16. Mailing Address*
18. City*
19. State*
20. Zip*
22. AMU Service Address is:*

    Select One.

    1. Same as Mailing address

    1. Add Service Address
24. Service Address*
25. City*
27. Phone Number*
28. Email Address
30. Primary Use for this location:
    -- Select One --Convenience StoreEducation-Community College UniversityEducation-PrimaryEducation-SecondaryHealth/Medical ClinicHealth/Medical HospitalLodging ManufacturingOffice-Low RiseOffice-Mid RiseOffice- High RiseRestaurantRetail - Large Department StoreRetail - Strip MallWarehouseOther/Misc
32. Purchase Information
34. Have you purchased the Energy Saving Equipment yet?*

    1. Yes
    2. No
36. Has the equipment been installed yet?*

    1. Yes
    2. No
    3. Other
38. Please explain
40. Vendor Name*
42. Vendor Contact
44. Vendor Address
46. City*
47. State*
48. Zip
50. Upload Your Invoice

    Invoice(s) submitted must include itemized quantity, price, manufacturer’s make and model numbers, and product codes for each material item and/or original equipment manufacturer (OEM) specification sheets.

52. Upload Invoice Documentation 2 (optional)
54. Upload Other Documentation (optional)
56. Equipment Information
58. Upload Equipment Specs
60. Describe Old Equipment*

    Give relevant details of Equipment being replaced such as energy consumption, wattage, RPMs, HP, etc. 

61. Annual Operating Hours of Old Equipment*

    Current

63. Describe New Equipment*

    Describe how new equipment, include energy details such as consumption, wattage, RPMs, HP, etc.

64. Annual Operating Hours of New Equipment*

    Currently or planned

66. Tell us how this change of equipment will save energy and/or why you think it may qualify for rebate?*
68. Disclaimer & Signature
70. Check this box to agree to the following:*

    1. I certify that all the information provided is accurate including claims of efficiency, size and customer information. I agree that AMU may verify all the information I have provided.
72. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
74. Electronic Customer Signature*

    *Must have an AMU account holder name here.  Any other name not listed on the utility bill will result in rejection of this rebate application.

Leave This Blank:


76. 1. Receive an email copy of this form.
77. Email address

    This field is not part of the form submission.

78. Submit Submit and Print

* indicates a required field