Form 5900-33 ENERGY STAR Commitment Form

United States

ENVIRONMENTAL PROTECTION AGENCY

and DEPARTMENT OF ENERGY

Washington, D.C. 20460

ENERGY STAR® Commitment Form:

Program Area(s) Where ENERGY STAR Partner

Commits to Fulfill Program Requirements

Office of Atmospheric Programs

Partner Name:

Date:

Partner agrees to fulfill the Program Requirements of each program area checked below.

Promote ENERGY STAR as an Energy

Label and Promote ENERGY STAR Qualified Products

Efficiency Program Sponsor* in the:

Appliances

Consumer Product Market

Clothes Washers

Residential New Construction Market

Compact Refrigerators

Existing Commercial Buildings Market

Dishwashers

New Commercial Buildings Market

Refrigerators and/or Freezers

Industrial Market

Room Air Conditioners

* Such as states, utilities, or regional program coordinators

Commercial Food Service Equipment

Help Clients Improve Their Energy Performance

Commercial Fryers

Commercial and Industrial Service and Product Providers,

Commercial Hot Food Holding Cabinets

supporting the:

Commercial Solid Door Refrigerators/Freezers

Existing Commercial Buildings Market

Commercial Steamers

New Commercial Buildings Market

Industrial Market

Home Electronics

Audio Equipment and DVD Products

Digital-to-Analog Converter Boxes (DTAs)

Offer Consumer Financing

Telephony

Financing for Energy-Efficient Products

Televisions and VCRs

Mortgages for Energy-Efficient Homes

Heating, Ventilation, and AC Products

Label and Promote ENERGY STAR Qualified Homes

Boilers

Home Builders/Developers

Central ACs and Air-Source Heat Pumps

Home Energy Raters

Furnaces

*Please refer to the ENERGY STAR Partnership

Geothermal Heat Pumps

Agreement for Home Builders and Verification

Light Commercial HVAC

Organizations.

Programmable Thermostats

Residential Ceiling Fans

Promote ENERGY STAR Qualified Products

Residential Ventilating Fans

Retailers/E-tailers

Buying Groups

Home and Building Envelope Products

Residential Insulation Products

Roof Products

Windows, Doors and Skylights

Window Components

Through our partnership with ENERGY STAR,

we also commit to improve the energy

Lighting Products

performance of our own facilities.

Exit Signs

Residential Light Fixtures

Screw-Based Compact Fluorescent Lamps (CFL)

Office Equipment

Computers

Imaging Equipment

Monitors

Other Products

Battery Charging Systems (BCSs)

End-Use Products with Qualified EPSs

External Power Supplies (EPSs)

New Refrigerated Beverage Vending Machines

Rebuilt Refrigerated Beverage Vending Machines

Residential Dehumidifiers

Room Air Cleaners

Water Coolers

Partner Name:

Date:

Please provide contact information for each program area selected on page 1.

(Make extra copies of page 2 when joining multiple program areas.)

ENERGY STAR Program Area:

Responsible Agent of Company:

Primary Contact (if different):

Contact Name:

Title:

Company:

Address:

City:

State:

Zip:

Country:

Phone:

Fax:

E-mail:

Additional Contact (marketing, etc.):

Additional Contact (if appropriate):

Contact Name:

Title:

Company:

Address:

City:

State:

Zip:

Country:

Phone:

Fax:

E-mail:

If you are a manufacturer of clothes washers, compact refrigerators, dishwashers, refrigerators and/or freezers, room air conditioners, windows/doors/skylights, or window components, please return to the attention of:

Please return to the attention of:

[email protected]

[email protected]

or

or

ENERGY STAR

ENERGY STAR

c/o ICF International

c/o D&R International

1725 Eye Street, NW, Suite 1000

1300 Spring Street, Suite 500

Washington, DC 20006

Silver Spring, MD 20910

Fax: (202) 862-1144

Fax: (301) 588-0854

EPA Form No. 5900-33 OMB Control No. 2060-0528 The public reporting and recordkeeping burden for this collection of information is estimated to average 11 hours per response. Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.