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Washing Machine Rebate Application

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Please correct the field(s) marked in red below:

Apply for a Residential Washing Machine Rebate

Apply for a $50 rebate when you purchase and install a new Energy Star qualified Washing Machine. 

Limit: One washing machine rebate per customer per household. 

 


1

I live in a single-family residence within the Hillsboro Water Department service area with a single or master meter. This includes houses, condominiums, duplex/multiplex residences and manufactured homes. 
Note: Apartment owners and residences supplied by our wholesale customers currently DO NOT qualify for these rebates.

 *
I live in a single-family residence within the Hillsboro Water Department service area with a single or master meter. This includes houses, condominiums, duplex/multiplex residences and manufactured homes. Note: Apartment owners and residences supplied by our wholesale customers currently DO NOT qualify for these rebates.
2

I am the point of contact on the Hillsboro Water account. 

 *
I am the point of contact on the Hillsboro Water account.
3
I have a current Hillsboro water account that is not past due. 
 *
I have a current Hillsboro water account that is not past due.
4
I have purchased and installed a new Energy Star qualified Washing Machine within the last 90 days.
 *
I have purchased and installed a new Energy Star qualified Washing Machine within the last 90 days.

5
Customer Information
 *
Customer Information
6
Please select the residence type and enter the name of the property (if applicable).
Please select the residence type and enter the name of the property (if applicable).
7

Washing Machine Information*

*Note: Washing machine must be Energy Star rated.

 *
Washing Machine Information* *Note: Washing machine must be Energy Star rated.

Applications must include a copy of a proof of purchase receipt from a retailer or plumbing company that specifies the purchaser’s name, purchase date, purchase price, manufacturer and model number. 


Please email a copy of your receipt to WaterRebates@Hillsboro-Oregon.gov. 

If you are unable to email the receipt, you may send it by mail with a copy of this form.

After you submit this online form, you will receive a copy of the form via email.


Please print the email and send it along with your proof of purchase to: 

Hillsboro Water
Attn: Rebates
150 East Main Street
Hillsboro, OR 97123


8
Check List
Check List

9
 I certify the information I have provided is true and correct, and I have purchased the products for use at the location indicated. I grant permission to Hillsboro Water Department, with notification, to enter upon the property to inspect the installation of rebate products to assure program requirements are met. I understand rebates are distributed on a first‐come first‐served basis until all funds are distributed, and may be discontinued at any time without notice. I have read and understand the terms and conditions of the Hillsboro Water Rebate program, and have checked Hillsboro's Water Efficiency Rebates page for any program updates.
 *
10
Electronic Signature
 *
Electronic Signature
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