BIG High Efficiency Toilet, Urinal & Flush-Valve Rebate Get a rebate of up to $75 per fixture for replacing water wasting toilets, urinals and flush valves. Property owners and managers can significantly reduce water bills by replacing inefficient toilets (models that use more than 1.6 gallons per flush (gpf) for toilets or 1.0 gpf for urinals) with EPA WaterSense labeled models. Eligibility Requirements Call 503-848-3064 for preapproval before proceeding with the rebate! 66 Receive $75 per fixture when you replace toilets that use more 1.6 gpf or urinals that use more than 1.0 gpf with EPA Water Sense labeled HETs or urinals. For a list of qualified models, visit www.tvwd.org. 66 Flush-valve HETs are not currently labeled by the EPA WaterSense program, however they may still qualify for a rebate. 66 Applicants must be a Tualatin Valley Water District business, industry, government, or multi-family housing customer with a TVWD water account in good standing. NOTE: Customers in the Southwood Park Water District and Valley View Water District currently DO NOT qualify for these rebates. 66 Applications must include a copy of a proof of purchase receipt from a retailer or plumbing company that specifies the purchase date, purchase price, manufacturer and model number. 66 The application must be received by TVWD within 90 days of purchase date. 66 Prior to approval, an on-site inspection will be required by TVWD to verify installation. 66 The total rebate per item will not exceed the receipt amount. 66 Rebates are for newly purchased products and fixtures only. Pre-existing products, labor and accessories (wax rings, seats, etc.) are not eligible. Did TVW you k ana D offe now th at lysi rs ass s, on-s free bi ll e ite ss othe r too ments water use and ls to w Cal ater e help y l (50 ffici ou e for m 3) 848 ntly? 30 ore info 64 ! How To Apply 1. Call TVWD at (503) 848-3064 for preapproval of the rebate. 2. After purchasing and installing the materials for the project per the eligibility requirements outlined above, fill out this rebate application form completely and attach a copy of the receipt or sales invoice. 3. Choose the most convenient option to submit the application and receipt: Mail: TVWD, Attn: Rebates, 1850 SW 170th Ave, Beaverton OR, 97006 Fax: 503-356-3164 E-mail: [email protected] TVWD will contact you within two weeks after we receive your rebate application to schedule the project inspection. Get answers to the most Frequently Asked Questions (FAQs) about rebates by visiting www.tvwd.org or call 503-848-3064. Please allow 4-6 weeks for processing. For more tax credit & rebate info visit: www.oregon.gov/ENERGY and www.energytrust.org 5/11 Download a QR scanner app on your smartphone and take a picture of our QR code for more information Business, Industry, Government and Multi-Family High-Efficiency Toilet & Flush Valve Rebate Application Customer Information ̉̉ Own building ̉̉ Lease building Company/Institution Installation Address Type of Business City State Zip TVWD Account Number Year building constructed/remodeled ̉̉ Office ̉̉ Institutional ̉̉ Food Service ̉̉ Multi-Family ̉̉ Production ̉̉ Other (Specify) _________ Property Owner Contact Information Check here if mailing address is same as installation address Contact Name Contact Title Contact Phone Mailing Address Contact Fax Contact E-mail Toilet Rebate Information WaterSense Labeled Tank-Type HETs City State Zip Check ̉̉ TVWD Account Holder One ̉̉ Authorized Agent WaterSense Labeled Urinals or Flush-Valve HETs* Number Replaced Cost Per Unit Number Replaced Cost Per Unit Manufacturer Model Number Manufacturer Model Number Dealer/Branch Date Purchased Dealer/Branch Date Purchased Rebate(s) will be credited to your account. If you would like a check, please mark this box. Check one: We will replace all our toilets at one time We will replace our toilets in phases (attach work plan) Would you like free water-efficient showerheads and faucet aerators? Showerhead # ______ Aerator # _______ Please contact me about a FREE water use assessment and recommendations for water savings. *Flush Valve HETs are not currently labeled by the EPA WaterSense program, however they may still qualify for a rebate. Call 503-848-3064 before proceeding with a flush-valve HET rebate. I certify the information I have provided is true and correct. I grant permission to Tualatin Valley Water District, with notification, to enter upon the property to inspect and ensure program requirements are met. I understand rebates are distributed on a first-come first-served basis until funds are distributed. Signature Date Office Use Only Approved By Date 5/11 Not Approved By Letter Sent