Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Residential Refrigerator Replacement Program

  1. Account Holder Information
  2. (English, Spanish, or Other)
  3. The Refrigerator Replacement Program is $20.00 per month for 12 consecutive months, for a total of $240.00. This will be added directly on your utility bill. Your current Refrigerator must be in working condition in order to apply for the program. Current refrigerator must be between 10 and 30 cubic feet in size. Someone 18 years or older must be present at time of delivery.
  4. Do you agree to these terms?*
  5. After submitting this form, your information will be provided to our third party contractor, the Appliance Recycling Center of America (ARCA). ARCA will contact you for delivery and exchange.

    For more information or if you do not agree to the terms, please contact the Electric Department at (909) 370-6139.
  6. Leave This Blank:

  7. This field is not part of the form submission.