Alameda Power and Telecom (A Department of the City of Alameda)    Refrigerator Rebate and Recycling Program Application

Important! You must recycle your old refrigerator with our recycler. Call 510-748-3949 to schedule a pick up.

Due to possible labeling errors, please verify that the refrigerator you are buying is Energy Star ® qualified by calling:

1-888-STAR-YES (toll free), or
510-748-3949, or
Check the Energy Star website:
http://www.energystar.gov/index.cfm?c=refrig.pr_refrigerators
Only refrigerators that appear on the Energy Star list qualify for the rebate.

Please print this page and mail the completed application along with your sales receipt to:

Alameda Power & Telecom
P.O. Box H
Alameda, CA 94501

To be completed by the customer:
Name: _________________________________________
Address: _________________________________________
Phone No.: _________________________________________
Account No.: _________________________________________

I agree to abide by the rules of Alameda Power & Telecom's Efficient Refrigerator Rebate and Recycle Program. I will not re-use, sell, or give away my existing refrigerator. My existing refrigerator must be picked up at my home by Freon Free to be properly recycled. I attest that the qualifying new refrigerator is for personal use in Alameda Power & Telecom's service area and will not be resold.

Signature: _________________________________________
Date: _________________________________________
To be completed by the retailer:
Store: _________________________________________
Address: _________________________________________
Phone No.: _________________________________________
Brand: _________________________________________
Model No.: _________________________________________
Date Purchased: _________________________________________

I agree to abide by the rules of Alameda Power &Telecom's Efficient Refrigerator Rebate and Recycle Program. I attest the above refrigerator was purchased at the above store and the customer was given a sales receipt stating the date of purchase. I will not accept the customer's existing refrigerator. The existing refrigerator must be picked up and recycled by Freon Free.

Signature: _________________________________________
Date: _________________________________________