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Water Efficiency Rebate Form

Pool Cover

Contact Information

First Name

Last Name

Account Number

Property Type

Address (as it appears on bill)

City

Phone Number

Email

How Did You Hear About this Rebate Program?

Rebate Information

Pool Cover Manufacturer

Pool Cover Model

Size of Pool (in square feet)

PCWA Treated Customer

Optionally, you can provide us any comments

Provide Attachments

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 Receipt(s)

Drag & drop

your receipt(s) here or click to browse

Attach Pool Cover installed photo(s)

Drag & drop

your pool cover installed photo(s) here or click to browse

Acknowledge Terms & Conditions

I have read, understand, and agree to the Pool Cover Rebate Terms and Conditions.

I understand that PCWA reserves the right to have an Agency representative verify the installation of the product(s) at the service address on the application.

Check here to acknowledge terms and conditions

Release of Liability & Signature

Placer County Water Agency (PCWA) reserves the right to deny an application of any participant who does not meet all requirements as outlined. PCWA reserves the right to change the terms of this program at their discretion. PCWA cannot guarantee that the installation of the product(s) will result in lower water utility costs. The number of rebates is dependent upon the availability of program funds. Applications will be processed when all required information is provided by the applicant on a first-come, first-served basis.

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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