Water Efficiency Rebate Form

Irrigation Efficiencies

Contact Information

First Name

Last Name

Account Number

Property Type

Address (as it appears on bill)

City

Phone Number

How Did You Hear About this Rebate Program?

Rebate Information

Location of the irrigation equipment you plan to upgrade

Select all that apply

Front yardBack yardSide yard

Please specify how you would like to upgrade your irrigation system

Select all that apply

Conversion of existing high volume sprinkler systems to low volume drip irrigation systemsConversion of existing high volume sprinkler nozzles with low precipitation or rotary nozzlesInstallation of pressure regulating equipment or irrigation valves that reduce pressure to the irrigation systemRemoval of leaking or broken irrigation equipment and replace with new partsInstallation of irrigation system flow sensorInstall EPA WaterSense approved weather based irrigation controller(s)

Briefly describe your project plans

PCWA Treated Customer

Irrigation Method

Pre-Conversion Photograph Attachments

Photo Attachment Requirements:

Submit Five photographs
All photographs must be in color.
Irrigation system must be photographed while operating.
Stand far back enough to include your home, street, driveway, or fence as a reference point.
Street number or address must be visible in at least one photograph.
Photographs cannot be online images (i.e Google, Bing, etc.).
Altered photographs will result in application being ineligible for rebate (see II. E. on page 1).
Auto irrigation control valves (i.e. manifolds) must be included in at least one photograph.

Note - Only Image file formats can be uploaded (eg. .jpg, .png). PDF files cannot be uploaded here. If you are unable to attach the correct file type, or if any other issues with the attachments arise, you may select the box below and submit the files in an email.

Optionally, check here to email receipts and photos instead. Send email with attachments to rebates@pcwa.net with your name and account number in the subject line. Failure to do so may result in a delay or rejected application.

Attach (5) Photos

Drag & drop

your (5) photos here or click to browse

Acknowledge Terms & Conditions

Check here to acknowledge terms and conditions

You must agree to participate in a post-conversion site inspection conducted by PCWA to verify that all irrigation equipment is installed. You may not be required to be present; arrangements will be made by a PCWA Water Efficiency Specialist.

Check here to agree to an inspection

Release of Liability & Signature

PCWA may deny any application that does not meet all of the Program requirements. PCWA reserves the right to alter the Program at any time. PCWA does not warrant or guarantee lower water bills as a result of participating in the Program. PCWA is not responsible for any damage that may occur to participants' property as a result of this Program. The undersigned agrees to hold harmless PCWA, its directors, officers, and employees from and against all loss, damage, expense and liability resulting from or otherwise relating to the installation of irrigation efficiencies equipment. By signing this form I agree that I have read, understand, and agree to the Terms and Conditions of this rebate program.

You must sign this form by typing your name

Name

144 Ferguson Road
P.O. Box 6570
Auburn, CA 95604

Mon. - Thurs., 8am - 5pm

(530) 823-4850

Mon. - Fri., 8am - 5pm

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