                                                      OMB Control No. 2060-0528
                   

EPA Form No. 5900-33	ENERGY STAR Participation Form	1  OMB Control No. 2060-0528
                                                                               
                                                                             	 
 Partner Name:
 Date:
ENERGY STAR Program Area: 
Contact Name:
Title: 
Company:
Address:
City:
State:
Zip:
Country:
Phone:
Fax:
E-mail:
Contact Name:
Title: 
Company:
Address:
City:
State:
Zip:
Country:
Phone:
Fax:
E-mail:
Return completed Participation Form to:
Email Address
Responsible Agent of Company:
Primary Contact (if different):
Additional Contact (marketing, etc.):
Additional Contact (if appropriate):
If your organization has different contacts for multiple products or program areas (for example: appliances 
and home electronics, or manufacturing and retail sales), please fill out a separate Participation Form for 
each set of contacts. The stand-alone Participation Form can be found at: www.energystar.gov/join.
The public reporting and recordkeeping burden for this collection of information is estimated to average 6.15 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.
join@energystar.gov 
All other ENERGY STAR qualified products
partnership@energystar.gov 
Product Type
ENERGY STAR
c/o D&R International
500
1300
 Spring Street, Suite 
Silver Spring, MD  20910
Mailing Address
CFLs, clothes washers, dishwashers, 
freezers, integral LED lighting, refrigerators, 
residential water heaters, room air 
conditioners, windows/doors/skylights
ENERGY STAR
c/o ICF International
 Eye Street, NW, Suite 
1725
1000
Washington, DC  20006
EPA Form No. 5900-33	ENERGY STAR Participation Form	2  
