City of Beaverton Form

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Residential Rebate Application - Weather-Based Irrigation Controller

  1. Customer Information

  2. Required

  3. Required

  4. Required

  5. Required

  6. Required

  7. Required

  8. Required

  9. Device Information

  10.  Residential Weather-Based Irrigation Rebate $50

  11. Required

  12. Required

  13. Required

  14. Required

  15. Backflow Prevention Verification

  16. Please provide the following information for your approved backflow prevention assembly. This information can be found on your Annual Backflow Assembly Test Report, provided by your contractor or by inspecting the assembly. If you have questions about backflow, please contact your backflow contractor or email mailboxbackflow@BeavertonOregon.gov.

  17. Required

  18. Required

  19. Required

  20. I certify the information I have provided is true and correct, and I have purchased the product for use at the location indicated. I grant permission to the City of Beaverton, with notification, to enter upon the property to inspect the installation of rebate products to assure program requirements are met. I understand the rebate will be applied as a credit to my water account, a check will not be distributed. I understand rebates are distributed on a first-come first-served basis until funds are depleted, and may be discontinued at any time without notice. I have read and understand the terms and conditions of the City of Beaverton Rebate Program, and have checked the Beaverton website for funding status and any program updates, at www.BeavertonOregon.Gov/Rebates.

  21. Leave This Blank:

  22. This field is not part of the form submission.