Commercial Water Softener Rebate Application

Commercial Water Softener Rebate Program Application

Company Name(Required)

Installation Address(Required)

Street Address City State ZIP Code

Phone(Required)

Email(Required)

Send rebate check to (if different than above address)

Address

Street Address City State ZIP Code

Name(Required)

Address

Street Address City State ZIP Code

Old Water Softener

Manufacturer(Required)

Model Number(Required)

Estimated Age(Required)

Estimated Number of Bags of Salt Used Per Year(Required)

(See chart for instructions)

Untitled(Required)

Water Softener Replaced

Brine Reclaim

Blending Valve

Salt-Free Water Conditioner Installed

You must choose at least one option

Rebate Amount(Required)

Upload a copy of your receipt(Required)

Max. file size: 64 MB.

Use the follow file name: FirstInitial.LastName-DocumentName

Upload any other required documents

Max. file size: 64 MB.

Use the follow file name: FirstInitial.LastName-DocumentName

Your Name(Required)

Date(Required)