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Hot Summer Rebates Application and Entry Form for Appliance Giveaway

Must be residential member with at least 12 months of usage history at the current location
Home must be a served by a 200-amp service only, due to metering limitations.
Must be willing to complete this survey of initial questions (Submit your entry below)
Must be willing to answer future surveys of questions during the two-year project
Must be willing to allow Flint to install small in-home device (at Flint’s expense) inside your home

10 Grand Prize(s):

One or more GE Brillion appliance packages for ten member homes.

View Rules

Must be Completed to Qualify for Appliance Give-away

Flint Energies Account Number*	Home Street Address*
My Home is a... Single Family Home Other multifamily dwelling Apartment Vacation House or Cabin Mobile Home Condo or Townhome
Do you own or rent this home? Buying (Paying a Mortgage) Own Outright Rent
Who pays the following bills?
Electric Landlord Resident(s)	Water Landlord Resident(s)
Natural Gas Landlord Resident(s)	Is this home usually occupied year-round? Yes No
What is the square footage of heated and cooled living space in this home? Less than 1,000 1,000 - 1,499 1,500 - 1,999 2,000 - 2,499 2,500 - 3,000 Over 3000
Approximately what year was your home built? Before 1950 1950 - 1969 1970 - 1979 1980 - 1989 1990 - 1999 2000 - 2004 2005 - 2009 2010 or newer Don't know
How many males in each of the following age groups normally live in this residence? Include yourself.
0 to 6 years	7 to 18 years
19 to 30 years	31 to 45 years
46 to 64 years	65 years or older
How many females in each of the following age groups normally live in this residence? Include yourself.
0 to 6 years	7 to 18 years
19 to 30 years	31 to 45 years
46 to 64 years	65 years or older
How many people are typically present in the home during a normal weekday (Monday through Friday, approximately 8AM to 4PM - retired, children, not working, etc.)? 1 2 3 4 5 More than 5
How many pets do you own that live inside your home, staying there while you are gone for a part of the day? 1 2 More than 2
What was your 2010 total household income before taxes (gross income)? Less than $30,000 $30,000 - $59,999 $60,000 - $99,999 $100,000 or more Rather not answer Not sure
What is the highest level of education you have attained? No Diploma High School Diploma / GED Undergraduate or Associated Arts Degree Some Graduate Work Advanced (Graduate or Post-Graduate) Degree
Does anyone in your home own a "smart" phone (iPhone, Blackberry, Droid, etc.)? Yes No
Do you have Internet access in your home? Yes No
Do you have a landline telephone in your home? Yes No, I only use a cell phone or have no phone service
How many of each of the following electric appliances do you have in your home? Central Air Conditioner Personal Computer Central Heat Pump Game Console for TV Room Air Conditioner Home Computer Microwave Oven Programmable Thermostat Refrigerator or Refrigerator/Freezer Combination Dehumidifier Stand-alone Freezer Air Purifier Dishwasher Well Pump Clothes Washer Swimming Pool Electric Water Heater Spa or Hot Tub TV (older style, with picture tube) Water Bed Heater TV - Flat Screen Ceiling Fan Digital Video Recorder (DVR) Whole House Fan Satellite Dish
Do you have air conditioning in this home? Yes, Central AC 1 individual room unit 2 individual room units 3 or more individual room units There is NO air conditioning in this home
Please Indicate how often your central air conditioning system is used during the summer
Day Almost Never Not Very Frequently Sometimes Very Frequently Almost Always
Night Almost Never Not Very Frequently Sometimes Very Frequently Almost Always
What is your typical summer temperative (thermostat) setting? 54° F or lower 55° - 59° F 60° - 64° F 65° - 69° F 70° - 74° F 75° - 79° F 80° - 84° F 85° F or above	What is your typical winter temperature (thermostat) setting? 54° F or lower 55° - 59° F 60° - 64° F 65° - 69° F 70° - 74° F 75° - 79° F 80° - 84° F 85° F or above
Please indicate the fuel used by the following appliances/systems, and give the age of the appliance.
Kitchen Oven/Range Electricity Gas or Propane I do not have this appliance
Age of this appliance
Primary Heating System Gas furnace Electric furnace Electric wall heater/baseboard heater Hot water/radiator Wood stove/coal stove Air source heat pump Ground source heat pump Space heaters I do not have this appliance
Age of this appliance
Can you heat this home entirely with this secondary heating system? Yes No Unsure No Secondary System
Water Heater Electricity Natural gas Propane I do not have this appliance
Age of this appliance?
Clothes Dryer Electricity Gas or propane Other I do not have this appliance
Age of this appliance
How old is your refrigerator?
How old is your air conditioning system, if you have one? (estimate)
Do you consider yourself a gadget person? Yes No
Do you like to own the first and the newest electronics? Yes No
How many compact fluorescent light bulbs (the corkscrew “CFL” bulbs) are in use in your home? None 1-2 4-8 9-15 16 or more
Please rate your concern regarding the following issues:
Global Climate Change Not concerned at all Not very concerned Unsure Somewhat concerned Extremely concerned	Energy Conservation Not concerned at all Not very concerned Unsure Somewhat concerned Extremely concerned
Sustainable Living Not concerned at all Not very concerned Unsure Somewhat concerned Extremely concerned
Do you think your electric usage is a private matter that should not be discussed with your neighbors? Yes No