Water Wise Rebates Form

Instructions

All fields below marked with an asterisk (*) are required. Please make sure that all these fields are populated before sending your application. If you try to send an application without one of these fields, the form will not accept your submission and you will need to review your form to populate these accordingly.
Customer Information
First Name*
Last Name*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Mailing Address
Street*
City*
State*
ZIP*
Where did you hear about the Water Wise Spokane Program?*

Blog or PublicationUtility BillSocial Media (Facebook/Instagram)Word of MouthWebinar or WorkshopSearch Engine (Google, Yahoo, Bing)Other
Other (Please describe)
Have you participated in the Water Efficiency Check-Up program?

YesNo
Check out the Water Efficiency Check-Up program!
Installation Information
Utility Account Number*
Same Mailing and Installation Address?*

YesNo
Installation Address
Street*
City*
State*
ZIP*
Hidden Install Street
Hidden Install City
Hidden Install State
Hidden Install ZIP
Description of Project

0/500
Sector*

ResidentialNon-Residential
Building Type Answer Value
Building Type*
Building Type*
Program Type*

Residential Indoor RebatesResidential Outdoor Rebates/Audits
Program Type*

Non-Residential Indoor RebatesNon-Residential Outdoor Rebates/Audits
Rebate Information
Rebate Category Answer Value
Rebate Category*
Rebate Category*
Rebate Category*
Rebate Category*
NOTE: To approve the rebate, a final inspection is required to verify the irrigation controller was installed and programmed correctly. After completing this form, you will be sent an email to schedule the inspection.
I Understand*
How many zones does your irrigation system have?*
Were all sprinkler heads replaced with rotary nozzles in this zone?*
If you selected no, please explain why*
Manufacturer*
Model*
Quantity Answer Value
Quantity*
Quantity*
Quantity*
NOTE: If your installation exceeds a quantity of 50, please reach out to waterwise@spokanecity.org to check on funding.
Total Product Cost ($)*
Installed By*

ResidentContractor
Installation Date*

MonthDayYear
Date
Details
Did you use a SpokaneScape Certified Pro?

YesNo
Which SpokaneScape Pro did you use?
Supporting Information

You can click on the "Add File..." button to upload up to 5 documents
Receipt*

Cancelof
Photo of Installed Product*

Cancelof
Terms and Conditions

By applying for City of Spokane Water Wise Rebates, you have read, understand, and agree to the following:
- I understand when my application is processed a representative from the City of Spokane may contact me to verify the installation of my new water efficient equipment before my rebate is issued.
- In accepting this rebate, I acknowledge that the City of Spokane is in no way responsible for the condition of the plumbing on my side of the meter, now or in the future.
- I understand that qualifying items are selected on the basis of water efficiency only. The City of Spokane does not endorse specific brands, products, or dealers; nor does it guarantee materials, workmanship, performance, or durability of the qualifying items.
- I understand I may receive reimbursements not to exceed the amount outlined in the program guidelines.
- I understand that if I qualify for $600 or more in rebates from the City in a calendar year that I must submit a W-9 form before receiving those rebates.
By checking the "I agree" button, you confirm that you have read and agree to terms and conditions.
By checking the "I agree" button, you confirm that you have read and agree to terms and conditions.
I Agree
Should be Empty:

Customer Information

Mailing Address

Installation Information

Installation Address

Rebate Information

Supporting Information