5900-34 ENERGY STAR Participation Form - Product Brand Owner

OMB Control No. 2060-0528
Approval expires: November 30, 2025

ENERGY STAR® Participation Form
for Product Brand Owner of ENERGY STAR Eligible Products:
Partner Name:
Date:
List of brand(s) that will be submitted for ENERGY STAR certification:

Product Brand Owner (Manufacturer)
Organization Type:
Product Brand Owner (Labeler)
(Hold Ctrl to select multiple)
Product Brand Licensee

Markets where ENERGY STAR United States
products will be shipped:
Canada

Brand Owner (Labeler): Organization that labels products manufactured by another company with its own brand(s).
Brand Owner (Manufacturer): Organization that manufactures products and labels them with its own brand(s).
Brand Licensee: Organization that manufactures products and labels them with a brand they have licensed from a brand owner organization.

Note: Partnership is only available for product brand owners who sell products eligible for ENERGY STAR certification in
the U.S./Canada under the brand(s) listed. Consistent with the Partnership Commitments referenced in the terms of the
Partnership Agreement:
1. The Partner is required to adhere to third-party certification requirements, including verification testing; and
2. The Partner is required to submit annual unit shipment data by March 1st for the previous Calendar Year.
Partner will certify the following ENERGY STAR products. Please select only those check boxes relevant for your
organization. Please fill out a separate Participation Form if you would like to participate in other program
areas (e.g., ENERGY STAR retailer) at www.energystar.gov/join.
Residential Appliances
 Clothes Dryers
 Clothes Washers
 Dehumidifiers
 Dishwashers
 Refrigerators and/or Freezers
 Residential Electric Cooking
Products
 Room Air Cleaners
 Room Air Conditioners

Office Equipment
 Computers
 Computer Servers
 Data Center Storage
 Displays
 Imaging Equipment
 Large Network Equipment
 Uninterruptible Power
Supplies
Home Electronics

Commercial Food Service Equipment
 Commercial Coffee Brewers
 Commercial Dishwashers
 Commercial Electric Cooktops
 Commercial Fryers
 Commercial Griddles
 Commercial Hot Food Holding Cabinets
 Commercial Ice Machines
 Commercial Ovens
 Commercial Refrigerators and Freezers
 Commercial Steamers

 Audio/Video Equipment
 Telephony
 Televisions
Home and Building Envelope
Products
 Residential Insulation Products
 Residential Storm Windows
(available for certification in the
United States only)
 Windows, Doors and Skylights

Lighting Products
 Decorative Light Strings
 Downlights

Heating, Ventilation, and AC Products
 Boilers
 Central ACs and Air-source Heat Pumps
 Commercial Boilers
 Connected Thermostats
 Furnaces
 Geothermal Heat Pumps
 Light Commercial HVAC
 Residential Ceiling Fans
 Residential Ventilating Fan
Other Products
 Electric vehicle Supply Equipment
 Laboratory Grade Refrigerators and
Freezers
 Pool Pumps
 Refrigerated Beverage Vending
Machines
 Smart Home Energy Management
Systems
 Water Coolers
Water Heaters
 Commercial Water Heaters
 Residential Water Heaters—Non- solar
 Residential Water Heaters—Solar

This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No.
2060-0528). Responses to this collection of information are voluntary (Section103(g) of the Clean Air Act). An agency may not conduct or
sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The
public reporting and recordkeeping burden for this collection of information is estimated to be 7.4 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 to the Regulatory Support Division Director, U.S. Environmental Protection Agency (2821T), 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.

EPA Form No. 5900-33

ENERGY STAR Participation Form

1

OMB Control No. 2060-0528
Approval expires: November 30, 2025

Primary Contact (if same as signatory contact, leave this blank)
Contact Name
Title
Company
Address
City

Role in Company (Hold Ctrl to select multiple)
Communications / Marketing / PR
Owner / Executive Management
Government Affairs / Corporate Relations
Legal
Technical / Engineering
Other

State
Zip
Country
Phone
Email

Additional Contact 1 (optional)
Contact Name

Role in Company (Hold Ctrl to select multiple)

City

Communications / Marketing / PR
Owner / Executive Management
Government Affairs / Corporate Relations
Legal
Technical / Engineering
Other

State

Role in ENERGY STAR Program

Zip

General (receive all ENERGY STAR correspondence)
Product Specific

Title
Company
Address

Country
Phone
Email

Enter product types (from page 1) that apply to your responsibilities:
Product Lead contact for:

_________________________

Compliance contact for:

_________________________

Unit Shipment Data contact for:

_________________________

Marketing/Communications contact for: _________________________
Specification Development contact for _________________________
(Product Specific Contacts only)

Return completed Participation Form to:

join@energystar.gov or
ENERGY STAR
c/o ICF
2550 S. Clark St, Suite 1200
Floor Arlington, VA 22202

EPA Form No. 5900-33

ENERGY STAR Participation Form

2

OMB Control No. 2060-0528
Approval expires: November 30, 2025

Additional Contact 2 (optional)
Contact Name
Title
Company
Address
City
State
Zip

Role in Company (Hold Ctrl to select multiple)
Communications / Marketing / PR
Owner / Executive Management
Government Affairs / Corporate Relations
Legal
Technical / Engineering
Other
Role in ENERGY STAR Program
General (receive all ENERGY STAR correspondence)
Product Specific

Country
Phone
Email

Enter product types (from page 1) that apply to your responsibilities:
Product Lead contact for:

_________________________

Compliance contact for:

_________________________

Unit Shipment Data contact for:

_________________________

Marketing/Communications contact for: _________________________
Specification Development contact for _________________________

Additional Contact 3 (optional)

(Product Specific Contacts only)

Contact Name

Role in Company (Hold Ctrl to select multiple)
Communications / Marketing / PR

Title
Company
Address
City
State
Zip

Owner / Executive Management
Government Affairs / Corporate Relations
Legal
Technical / Engineering
Other
Role in ENERGY STAR Program
General (receive all ENERGY STAR correspondence)
Product Specific

Country
Phone
Email

Enter product types (from page 1) that apply to your responsibilities:
Product Lead contact for:

_________________________

Compliance contact for:

_________________________

Unit Shipment Data contact for:

_________________________

Marketing/Communications contact for: _________________________
Specification Development contact for _________________________

(Product Specific Contacts only)
Return completed Participation Form to:

join@energystar.gov or
ENERGY STAR
c/o ICF
2550 S. Clark St., Suite 1200
Arlington, VA 22202
EPA Form No. 5900-33

ENERGY STAR Participation Form

3