Residential Water Softener Rebate Application

Residential Water Softener Rebate Program

Name(Required)

First Last

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)

Untitled(Required)

Softener replaced 4000 – 4999 gr/lb ($500)

Softener replaced > or = 5000 gr/lb ($700)

Efficiency retrofit ($150)

Salt-free conditioner (requires pre-approval)

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)