City of Beaverton Form

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Water Efficient Appliances - Toilet Rebate

  1. Customer Information

  2. Required

  3. Required

  4. Required

  5. Required

  6. Required

  7. Required

  8. Required

  9. Rebate Information

  10.  Toilet #1 Rebate $75

  11. Required

  12.  Toilet #2 Rebate $75

  13.  Toilet #3 Rebate $75

  14. Attach Receipts

  15. 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.

  16. Leave This Blank:

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