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How do I fill this out?
To fill out this form, you need to provide your personal information, existing toilet details, and new toilet details, along with accepting the terms and conditions. Please read the qualifications carefully to ensure that you meet all the requirements before submitting the form.
How to fill out the Roseville Residential Toilet Rebate Program Details?
1
Provide personal information including name, address, and contact information.
2
Enter details about the existing toilets, including make, model, and gallons per flush.
3
Provide details about the new toilets to be installed, including make, model, and gallons per flush.
4
Agree to the terms and conditions of the rebate program.
5
Submit the form along with the required receipts and documentation.
Who needs the Roseville Residential Toilet Rebate Program Details?
1
Homeowners in Roseville who want to replace old, inefficient toilets.
2
Residents looking to reduce their water usage and utility bills.
3
Individuals who meet the program's qualifications and wish to apply for a rebate.
4
People who have already purchased new WaterSense approved toilets and need to claim a rebate.
5
Anyone with a City of Roseville Water Utility account interested in improving water efficiency in their home.
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What are the instructions for submitting this form?
Send the completed form and required documentation to Environmental Utilities, Water Efficiency Division, 2005 Hilltop Circle, Suite 110, Roseville, CA 95747. You can also fax it to (916) 774-5755 or email it to WaterRebates@roseville.ca.us. Ensure that the form is submitted within 60 days of purchase to be eligible for the rebate. My advice is to double-check all required information and documentation before submitting to avoid any delays in processing.
What are the important dates for this form in 2024 and 2025?
The program is available from July 1, 2023, through June 30, 2024, pending council approval.
What is the purpose of this form?
The purpose of this form is to enable homeowners in Roseville to apply for a rebate on new, more efficient toilets. By replacing older, non-conserving toilets, participants can reduce water usage and contribute to environmental conservation. This form outlines the qualifications, terms, and conditions for receiving the rebate.
Tell me about this form and its components and fields line-by-line.
- 1. Customer Name: Enter the full name of the applicant.
- 2. Service Address: Enter the service address where the toilets will be replaced.
- 3. Year Constructed: Enter the year the property was constructed.
- 4. Phone Number: Enter the contact phone number of the applicant.
- 5. Email: Enter the email address of the applicant.
- 6. Existing Toilet(s) Make and Model: Specify the make and model of the existing toilets to be replaced.
- 7. Gallons Per Flush: Enter the gallons per flush for the existing toilets.
- 8. New Toilet(s) Make and Model: Specify the make and model of the new toilets to be installed.
- 9. Gallons Per Flush: Enter the gallons per flush for the new toilets.
- 10. Number of Toilets to be Replaced: Enter the total number of toilets to be replaced.
- 11. Program Qualifications: Agree to the program qualifications by checking the appropriate boxes.
- 12. Authorized Signature: Sign the form to authorize and accept the terms and conditions.
- 13. Date: Enter the date of form completion.
What happens if I fail to submit this form?
If you fail to submit this form, you will not be eligible to receive the rebate.
- Missed Rebate Opportunity: Failure to submit the form on time means you will miss out on the rebate opportunity.
- Non-Compliance: Failure to comply with the program requirements and deadlines may result in disqualification.
How do I know when to use this form?
- 1. Applying for Rebate: Submit the form to apply for the toilet rebate.
- 2. Replacing Old Toilets: Use this form when replacing older, inefficient toilets with new, WaterSense approved models.
Frequently Asked Question
Can I edit this form on PrintFriendly?
Yes, you can easily edit this form on PrintFriendly using our PDF editor.
How do I fill out the Residential Toilet Rebate form?
Provide your personal information, details about the existing and new toilets, agree to the terms and conditions, and submit the form with the required documentation.
Do I need to have a pre-inspection before replacing my toilet?
Yes, a pre-inspection by the City of Roseville is required before you replace your toilet.
What is the rebate amount offered by the program?
The City of Roseville will rebate up to $100.00 for qualifying toilet models.
How long do I have to submit the rebate claim after the pre-inspection?
The rebate expires 90 days from the pre-inspection date.
Can I share the completed form on PrintFriendly?
Yes, you can share your completed form using PrintFriendly's sharing options such as email, social media, or a direct link.
What if my toilet model does not qualify for the rebate?
The City of Roseville will not be held liable for any toilets replaced with non-qualifying models.
How can I sign the form electronically?
Use PrintFriendly's e-signature feature to sign the form electronically and save the signed document.
Can professional installation costs be included in the rebate?
Yes, professional installation costs along with accessories like supply line, wax ring, and seat are covered under the rebate.
Where do I send my completed application form?
Send your completed application form to Water Efficiency Division, 2005 Hilltop Circle, Roseville, CA 95747, or email it to WaterRebates@roseville.ca.us.
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