Rebate Form | Cleveland v. Whirlpool Corp.

NAME AND CONTACT INFORMATION

Provide your name and contact information below. It is your responsibility to notify the Claims Administrator of any changes to your contact information after submitting your Claim Form.

First Name *

Last Name *

Street Address *

City *

State *

Zip Code *

Phone Number *

Email Address *

* Required Fields

Instructions

This rebate can be applied toward the purchase of a new KitchenAid-brand, Whirlpool-brand, or Maytag-brand dishwasher purchased on or after January 27, 2022 and before the rebate deadline of May 6, 2025. You can submit your completed Rebate Form online, via email or by traditional mail. You must include documentation demonstrating proof of purchase of a KitchenAid-brand, Whirlpool-brand, or Maytag-brand dishwasher on this Rebate Form.

This Rebate Form is transferable to any member of your household or member of your immediate family. If you are transferring the rebate to another household or immediate family member, indicate the name of that individual. The deadline to submit your completed Rebate Form and proof of purchase documentation through one of the methods below is May 6, 2025.

INFORMATION ABOUT YOUR REBATE ELIGIBLE DISHWASHER PURCHASE

Please complete all fields and upload your proof of purchase that reflects this information.

Date of Purchase *

Price Paid *

Model Number *

Serial Number *

*Do not include sales tax, delivery fees or installation charges.

Transfer of Rebate to another household or immediate family member

Complete this section ONLY if you are transferring the rebate. Leave this section blank if you are not transferring the rebate.

Check this box only if you are transferring your Rebate Form.

Name of the individual you are transferring the Rebate Form to.

Relationship to the person you are transferring the Rebate Form to.

SUPPORTING DOCUMENTATION

Accepted file types are: PDF, TIF, JPG, GIF, PNG. Other file types will be rejected. Please confirm in the grid below that your file has been successfully uploaded.

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CERTIFICATION STATEMENT

CERTIFICATION STATEMENT (Please note that you will not be eligible to receive any settlement benefit unless you sign and date this statement): I affirm that all information provided in this Rebate Form is true and accurate.

Signature *

Date

CLEVELAND, ET AL. V. WHIRLPOOL CORPORATION

Case No.: 20-cv-1906-WMW-KMM

UNITED STATES DISTRICT COURT DISTRICT OF MINNESOTA

Your Rebate Form has been submitted successfully.

Submitted Rebate ID:
Confirmation Code:
You will need the above Submitted Rebate ID and Confirmation Code if you would like to edit your Rebate at a later time, so please print this page for your records.
CLAIM INFORMATION
Full Name
Street Address
City
State
Zip Code
Phone Number
Email Address