RESIDENTIAL APPLICATION
TOWN of CARY PUBLIC WORKS AND UTILITIES DEPARTMENT
ATTN: HET REBATE PROGRAM
P.O. Box 8005
Town of Cary, NC 27512
(919) 469-4090
Residential High Efficiency
Toilet Retrofit Rebate Program Application
APPLICANT
INFORMATION- PLEASE PRINT
NAME:
________________________________ Circle one: Owner Occupant ACCOUNT #: __________________________
BILLING
ADDRESS (check mailed here): _______________________________________________________________________
SERVICE
ADDRESS (if different): _____________________________________________________________________________
CITY:
EMAIL:
_________________________________________________ Preferred method of contact (circle
one) EMAIL PHONE
REBATE
PROGRAM INFORMATION- PLEASE PRINT
Complete information about each toilet retrofit
below- limit three rebates per residential account.
Provide
either current toilet size, make and model- Make & model of new toilet
Fixture price Date installed
or the height, width and depth of
water level in tank
1. ___________________________________ _______________________
____________ ___________
2. ___________________________________ _______________________
____________ ___________
3.
___________________________________ _______________________
____________ ___________
I have read and understand
the rebate policy as stated in the program guidelines and I agree to a site
visit by a Town of
SIGNATURE
OF APPLICANT:________________________________________________
DATE:__________________________
FOR
OFFICE USE ONLY
APPROVED
(circle): 1 2 3 REBATE AMOUNT (circle):
Reason for disapproval: $150 $300 $450
SIGNED:
_______________________________________________ DATE:____________________
Water Conservation Technician
APPLICATION INSTRUCTIONS:
1. Confirm your old toilet is eligible by
either: (refer to program guidelines)
§
Providing the size, make and model stamped on the toilet, or
§
Measuring the height, depth and width of the water level (when full) in
the tank.
2.
Purchase and install WaterSense approved high efficiency toilet(s).
3.
Complete the appropriate rebate
application. There are two applications, one for residential accounts and one for non-residential accounts.
4. MAIL a completed application
with original dated receipt(s)
attached to the address above.
5.
A Town representative will contact you to schedule a site visit to verify
installation.
6.
A check will be mailed to the applicant within 4 weeks of the site visit
approval.
For
additional assistance, please call (919) 469-4090.