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Water Efficiency Rebate Form

High-Efficiency Clothes Washing Machine

Contact Information


Rebate Information

Does the new Washing Machine have a CEE Advanced tier, tier 1 or tier 2 water factor? Check here: https://www.cee1.org/content/cee-program-resources


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.
Attach Receipt(s)

Drag & drop

your receipt(s) here or click to browse

Attach Water-Efficient Clothes Washing Machine installed photo(s)

Drag & drop

your water-efficient clothes washing machine installed photo(s) here or click to browse


Acknowledge Terms & Conditions

I have read, understand, and agree to the High-Efficiency Clothes Washing Machine 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.


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

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