Clackamas River Water Providers

Rebate Application

Customer Information

Name ______

Installation Address ______

City ______State ___ Zip ______

Mailing Address ______

City ______State ____ Zip ______

Home Phone ______

Daytime Phone______

Email ______

Customer Signature ______

Please circle your water provider:

Ø  City of Estacada

Ø  City of Gladstone

Ø  Oak Lodge Water District

Ø  South Fork Water Board (Oregon City and West Linn)

Ø  Sunrise Water Authority (Happy Valley and Damascus)

Account

Number______

Rebate Information

  Landscape Rebate Combined $310 maximum

·  Rain Sensor/Switch: Actual cost – up to $25 maximum

·  Irrigation Controller: Actual cost – up to $200 maximum

·  Multi-Stream Rotating Irrigation Nozzle: up to $60 ($3 each, up to 20)

Approved Makes and Models. (Please circle appropriate make/model)

• Hunter MP Rotator: Model 1000  2000  3000 

• Rainbird Rotary Nozzles: Model R13-18  R17-24 

• Toro Precision Series (Rotary): Model PRN 

• Toro Precision Series (Sprays): Model PSN 

• All others must be of similar function and equal or exceed performance of pre-approved models to be considered.

• Make: ______Model: ______

·  Manual Hose bib Timer: up to $25 maximum

  Toilet Rebate up to $85 maximum + $15 additional for recycling your old toilet

Manufacturer and Model # ______

  Washing Machine Rebate up to $75 maximum

Manufacturer and Model # ______

To be considered for a rebate the following 3 items must be received by the

Clackamas River Water Providers:

ü  Rebate Application (This page, completed and signed)

ü  Sales Receipt/s or Invoice/s (original or a copy)

ü  For HET toilet recycling, receipt from recycling facility (original or a copy)

Customers can take advantage of each rebate one time per fiscal year (July 1st-June 30th), per account.

Mail to: CRWP Attn: Rebates, 14275 S. Clackamas River Dr. Oregon City, OR 97045

I certify the information I have provided is true and correct, and I have purchased the goods for use at the location indicated. I grant permission to Clackamas River Water Providers, with notification, to enter upon the property to inspect the installation of rebate goods to assure program requirements are met. I understand rebates are distributed on a first-come first-served basis until funds are exhausted.