NIPSCO Appliance Recycling Form

Contact information

Electric account number (*No dashes and only the first 9 numbers of your account number.)

Pickup address

(Must match the account service address.)

Street address Street address line 2

Appliance information

Appliance type

(See Eligibility Requirements below for unit limits.)

Note: In order to qualify for a window air-conditioner unit or dehumidifier pickup, you must also recycle an eligible refrigerator or freezer.

Refrigerator Type

Top freezer refrigerator

Bottom freezer refrigerator

Side-by-side refrigerator

Single door refrigerator

French door refrigerator

Number of refrigerator units 1 unit 2 units

Freezer type

Upright freezer

Chest freezer

Number of freezer units 1 unit 2 units

Number of window air conditioner units 1 unit 2 units

Pickup information

Appliance location(s)

Note: Any units requiring 2 or more flights of stairs to access must be accessible by a functioning elevator.

Mailing information

Is the Mailing Address the same as the Pickup Address? Yes No

Rebate address

Street address Street Address line 2

City

State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

ZIP Code

How did you hear about this program?^? NIPSCO Email Manufacturer Retailer NIPSCO bill insert or direct mail Word of mouth or referral Internet search Past participation Social media NIPSCO website

Terms and conditions

By submitting this request, I certify and represent that I am the owner of or the authorized representative of the owner of the listed appliance(s). I authorize my electric utility partner, CLEAResult, to remove my appliance(s) for recycling. I confirm that the appliance(s) meets utility requirements for participation in this program, including being in working condition, within the size requirements (refrigerators- 10-30 cu ft; freezers- residential-sized; window air conditioners and dehumidifiers and picked up at a location listed on the billing account.

Eligibility requirements:

✔ Participant must be a NIPSCO residential electric customer with active service.

✔ Appliance must be a working and cooling refrigerator, freezer, dehumidifier, or window air conditioner.

✔ Dorm size and oversized refrigerators and freezers are not eligible for the Appliance Recycling Program.

✔ The customer must own the appliance and any refrigerators or freezers must be between 10 to 30 cubic feet in size.

✔ The appliance must be plugged in, working and cooling and empty at the time of pick-up.

✔ The unit being recycled should not be replaced by another unit.

✔ Appliance must be accessible with a clear and safe path for removal.

✔ Any units requiring 2 or more flights of stairs to access must be accessible by a functioning elevator.

✔ Water line must be disconnected prior to pickup.

✔ Address for account number and pick up must be the same.

✔ Rebate will be mailed within approximately eight weeks of appliance pickup.

✔ There is a limit of two (2) large appliances (refrigerators and freezers) and two (2) small appliances (room air conditioner or dehumidifier) per household, per year.