2009 CASH REWARD CLAIM FORM— MINNESOTA

LIGHTING
You must complete all information to avoid claim denial or processing delays. (Cut from
product box) "

CUSTOMER INFORMATION
Person or Company Receiving Cash Reward Mailing Address (if different than installation address)

Installation Address City State Zip

City State Zip Name on IPL Acct.

IPL Acct. No. (at installation address) Contact Person Phone No.
_ _ _ _
( )
Building Type Approximate Year Building Was
Constructed (required)
❒ Single-Family ❒ Manufactured Home ❒ Multi-Family ❒ Retail ❒ Office ❒ Agriculture ❒ Church/School
Tax Status
❒ Residential ❒ Sole-Proprietor* ❒ Partnership* ❒ Government ❒ Non-Profit ❒ Corporation ❒ Religious
*If sole-proprietor or partnership, you must provide a Social Security or Federal Tax ID number and the associated legal name listed on the document.
SSN or Fed. Tax ID: Legal Name:

This Equipment Was Purchased

❒ To Replace Existing Working Equipment ❒ To Replace Existing Failed Equipment
❒ As New Equipment in Existing Building ❒ As New Equipment in Newly-Constructed Building
How did you find out about this IPL energy-efficiency program?
❒ Bill Insert ❒ Direct Mail ❒ IPL Rep. ❒ Internet ❒ Word-of-Mouth
❒ Newspaper ❒ Radio ❒ Television ❒ Dealer ❒ Other

ENERGY STAR® COMPACT FLUORESCENT LIGHT BULB INFORMATION

Complete for each type of bulb. Include information on a 3 x 5 index card, if necessary. * Minimum of 5 bulbs per claim,
Manufacturer Model# Bulb Wattage # of Units* Total Cost maximum of 25 bulbs per residential
customer account, and a maximum
__________________ ___________________ ___________________ __________________ $____________ of 50 bulbs per business customer
account, per year.
__________________ ___________________ _ __________________ __________________ $____________
Cash reward amount will equal 50
__________________ ___________________ _ __________________ __________________ $____________ percent of equipment purchase price.

__________________ ___________________ _ __________________ __________________ $____________

__________________ ___________________ _ __________________ __________________ $____________
__________________ $____________ x 50% = _________ Total Cash Reward
Total # of bulbs

For non-residential T-8, metal halide and high-pressure sodium fixture cash rewards, please call 1-866-255-4268 for alternate lighting cash reward claim form.

How did you find out about the Alliant Energy-IP&L Efficiency Program? CUSTOMER AGREEMENT
I certify that this lighting equipment was purchased between January 1, 2009 and December 31, 2009, and installed by February 28, 2010. All statements made in this application
are correct. I agree to the terms and conditions in the 2009 Cash Rewards booklet.
Customer Signature Date Donate your cash reward to IPL’s Hometown Care Energy Fund and help
local families in need (tax deductible). ❒ Yes ❒ No
Cut out the UPC code(s) and ENERGY STAR logo(s) from each product box, include model number(s) and copy of itemized sales receipt, along with completed claim form and mail
within 90 days of installation to: IPL • Energy-Efficiency Programs • P.O. Box 351 • Cedar Rapids, IA 52406-0351

FM-0625 REV. 2 LTNG MN 01/09