City of Sierra Vista

Untitled Document

Rebate Program
Registration Form

I wish to pre-register for participation in the following rebates:

I agree to replace one high-flow toilet with low-flow alternatives.
I agree to replace two high-flow toilets with low-flow alternatives.

I accept	Condition
	I understand that I am to retain my old toilet(s) for the City to pick-up.
	The City of Sierra Vista is in no way responsible for the selection or installation of the product(s) purchased or for any performance problems with the product(s) before, during or after installation.
	I have read, understand and agree to comply with the WATERtight Rebate Program participation requirements within 3 months of the date signed.
	I understand rebates subject to available funds.

Name
Street Address
City, State	Sierra Vista, AZ
Zip Code
Home Phone	(520)
Email Address
Year Home Built
Number of People in Household