Nebraska Energy Office Appliance Rebates

Nebraska ENERGY STAR® Appliance Rebate Provider Registration

To become a rebate provider you must:

Register with the Nebraska Energy Office by completing the online form and certifications below.
Be a commercial businesses in the state of Nebraska that sells NEW (not used) appliances, heating and cooling equipment and
Provide installation, if appropriate.

Information provided by the rebate provider will be verified prior to approval.

After registration, an email link will be sent to retailers to select a User ID to be used on the Program website. A default password will be provided to allow access to the secured areas of the website. After login in, providers are required to change the default password to a password they can remember.

Once registered, rebate providers are encouraged to become familiar with the rebate process and requirements. An Online tutorial is available to help rebate providers prepare to participate in the Appliance Rebate Program.

Questions about this process may be directed to Energy Office Rebate Questions. More information about the program details and eligibility rules can be found on the Energy Office Program Details webpage.

Program Launch Date: July 6, 2010
Program End Date: When funds are depleted.
Total Funding: $1,505,500 (As of July 6, $220,000 were reallocated from program administrative funds to rebates)

Application to Become a Registered Nebraska Energy Efficient Product Rebate Provider
Fill out the form completely and use upper and lower case proper names.

Name of Business:

Business Type: Appliance Retailer Heating/Cooling Company Contractor

Business Mailing Address:

City:

County:

Zip Code:

Contact Person’s Name:

Contact Person’s Phone Number:

Contact Person’s Email Address (registration confirmation is sent to this address):

Business Web Site: (Do not type http:// in the web address)

Store Locations, if More Than One (or physical address if different than mailing address):

Types of Rebates Your Business Will Be Offering (Click all that apply):

	YES	NO
Refrigerators
Clothes washers
Dishwashers
Gas/propane furnaces
Central air conditioners
Air source heat pumps

Request for Authorized Rebate Issuer Certifications

Please acknowledge the following statements by clicking the checkboxes. You will not be able to submit your request for an account without doing so:
I certify that I am applying on behalf of a business with location(s) in Nebraska that sells and/or installs products in Nebraska. Sales associates will have access to the Internet and a printer for purposes of preparing and printing customer rebate applications.

Further, I will provide information on voluntarily recycling old refrigerators that are being replaced through this program.

Finally, I agree to maintain records related to the Nebraska ENERGY STAR Rebate Program for at least three years and to make them available if needed for monitoring/auditing purposes.

For the purpose of complying with Neb. Rev. Stat. §§ 4-108 through 4-114, l attest as follows (Check One):

1. I am a citizen of the United States.

2. I am a qualified alien under the federal Immigration and Nationality Act. I agree to provide a copy of my USCIS documentation upon request.

Immigration status and alien number:

I hereby attest that my response and the information provided on this form and any related application for public benefits are true, complete, and accurate and I understand that this information may be used to verify my lawful presence in the United States.

Print Name:

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