SWEPCO Appliance Recycling Form

Contact information

Electric account number

Pickup address

Street address Street address line 2

Appliance information

Appliance type

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

Does the appliance work? Yes No

Pickup information

Appliance location(s)

Incentive information

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

Name of incentive recipient

First name

Last name

Why is incentive check going to a third party?

Mailing information

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

Incentive 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?^? Utility Email Manufacturer Retailer Utility bill insert or direct mail Word of mouth or referral Internet search Past participation Social media Utility website

Terms and conditions

Eligibility requirements:

✔ Appliance must be a working refrigerator or freezer.

✔ Appliance must be between 10 and 27 cubic feet.

✔ Appliance must be clean and plugged in.

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

✔ Water line must be disconnected prior to pickup.

✔ Appropriate physical pickup address must be provided.

✔ Incentive will be mailed within six weeks of appliance pickup.

✔ Maximum of 2 appliance type per calendar year.

** All fields are REQUIRED. Don't use characters (e.g., �&�) in any of the inputs.