Menu

High Efficiency Toilet Program Application

Applicant Information
Name (As shown in water bill) Email Water Account Number
Contact Name Phone Number Attach Water Bill
Installation Address
Address State
City Zip
Mailing Address

(Include if different from Installation Address)

Address State
City Zip
Purchase Information
Name of Store City of Store (if applicable)
Store Phone Number Attach Purchase Receipt
Purchased Items
Purchase Date Manufacturer Model Name
Model Number Purchase Price Quantity (1-20)

*Please include water bill and sales receipt with this application. Thank you!
Rebate Agreement and Release of Liability

By submitting the form, I agree that I have read, understand, and agree to the Rebate Program Guidelines and Conditions section. San Gabriel Valley Municipal Water District may deny any application that does not meet the requirements. Requirements are listed in the Rebate Program Guidelines section. The Agency does not guarantee the performance of any product or that the installation will be free of defects. The Agency also does not warrant the quality of the workmanship, or suitability of the premises. The undersigned further agrees to hold blameless San Gabriel Valley Municipal Water District and Thinking Green Consultants against loss, damage, expenses, and liability resulting from the loss, destruction or damages of the property arising out of or in any way connected with the installation. Rebates are processed on a first come, first serve basis. Please allow up to 6-8 weeks for your completed application to be processed. Incomplete applications will not be processed.