Residential Rebate Form

All fields marked with * are required and must be filled.

Preliminary Information Who bills for your water? *

Customer Information

Contact Name*

Distributor

Distributor is required

Account Number

If you live in a condo or apartment building, you will need to contact your manager for the account number.

Account Number

Federal Tax ID No.

Customer Type*

Phone number*

- -

No Email Address?

If you do not have an email address, you will not be able to apply online. Please call 303-893-2444 for assistance.

Email Address

Confirm Email Address*

Number of Occupants

Mailing Address

Address*

Unit No.

City*

State*

Zipcode*

Rebate information

Purchase Date*

Rebate Type

Please check the box next to the type of eligible product rebate you are applying for:
Full list of eligible products and models

WaterSense certified toilet

Up to $75. Must purchase WaterSense-labeled 1.28 gallon per flush toilet by Dec. 31, 2015, to qualify, and apply within 90 days to receive rebate.

Rotary/high-efficiency irrigation nozzles

$3 per nozzle. One-time rebate per 10 years. Minimum of 10 nozzles, maximum is 100.

Clothes Washer

Limited to one per customer every 10 years. The last day to purchase is Sept. 30, 2013; You must submit your rebate application within 90 days of the purchase date.

WaterSense Certified smart irrigation controller

Limited to one per residence. $75 per residence.

WaterSense certified toilet

Up to $100. WaterSense-labeled toilets that use an average of 1.1 gallons per flush (GPF) or less are eligible. Models that flush 1.28 GPF or dual flush toilets with a 1.6 GPF option do not qualify.

Product Type	Quantity
WaterSense labeled ultra high-efficiency toilet (1.1 gallon per flush or less)
Rotary/high-efficiency irrigation nozzles
WaterSense Certified smart irrigation controller	1

*Rebates subject to change at any time.

Installation Address

Same as Mailing Address

Address*
Unit No.
City*
Zipcode*

Receipt

How will you be sending us a copy of your receipt (proof of payment)? Receipt copy must include:

Purchase date
Brand and model
Price of each item
Proof that it was paid in full

Tip: Take a photo of your receipt with your smartphone and email it to yourself for easy upload

Upload copy of receipt to get rebate faster

Mail a copy of receipt to Denver Water

File types allowed to upload: jpg, jpeg, pdf, tif, and gif
File size limit: 5 MB
Maximum number of file allowed to upload: 5 files
Upload multiple files by browsing to each individually

Customer Feedback

How did you hear about our program?

What is your primary reason for participating in this program?

By checking the box below, I certify that the device was purchased and installed as indicated above. I understand that all documents, including receipts, become the property of Denver Water once submitted, and Denver Water reserves the right to randomly inspect my premise in order to verify installation of my new fixture prior to issuing my rebate. I understand that new construction does not qualify. Only new fixtures or appliances qualify; equipment that is used, leased, refurbished, rented, received from warranty or insurance claims, exchanged or won as a prize, do not qualify for this rebate. Rebate subject to available funds or discontinuation at any time. Application forms without complete information or a valid receipt will be returned to the applicant.

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