Appliance Recycling Form

Contact information

Electric account number

Pickup address

Street address Street address line 2

Appliance information

Note: Customers are limited to recycling one refrigerator or one freezer every seven years.

Appliance type

Refrigerator Type

Top freezer refrigerator

Bottom freezer refrigerator

Side-by-side refrigerator

Single door refrigerator

French door refrigerator

Freezer type

Upright freezer

Chest freezer

Does the appliance work? Yes No

Pickup information

Appliance location

Incentive information

Is incentive recipient the same as utility account holder? Yes No

Name of rebate recipient

First name

Last name

Why is rebate check going to a third party?

Mailing information

Is the mailing address the same as the pickup address? Yes No

Rebate address

Street address Street Address line 2

City

State Arkansas

ZIP Code

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

Terms and conditions

Eligibility requirements:

✔ Applicant must be an Entergy Arkansas residential customer.

✔ Appliance must be a refrigerator or freezer.

✔ Appliance must be between 10 and 32 cubic feet.

✔ Appliance must be in working (cooling) order, empty, clean and plugged in at the time of pickup.

✔ Water line must be disconnected.

✔ Appliance must be located at an Entergy Arkansas residential address.

✔ $25 incentive will be mailed as a check within six weeks of appliance pickup.

✔ Limit one refrigerator or one freezer per household per seven-year period.

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