BIG High Efficiency Toilet, Urinal & Flush-Valve Rebate

BIG High Efficiency Toilet, Urinal
& Flush-Valve Rebate
Get a rebate of up to $75 per fixture for replacing water wasting toilets, urinals and flush valves. Property owners and
managers can significantly reduce water bills by replacing inefficient toilets (models that use more than 1.6 gallons per
flush (gpf) for toilets or 1.0 gpf for urinals) with EPA WaterSense labeled models.
Eligibility Requirements
Call 503-848-3064 for preapproval before proceeding with the rebate!
66 Receive $75 per fixture when you replace toilets that use more 1.6 gpf or urinals that use more
than 1.0 gpf with EPA Water Sense labeled HETs or urinals. For a list of qualified models, visit
www.tvwd.org.
66 Flush-valve HETs are not currently labeled by the EPA WaterSense program, however they may
still qualify for a rebate.
66 Applicants must be a Tualatin Valley Water District business, industry, government, or multi-family housing
customer with a TVWD water account in good standing.
NOTE: Customers in the Southwood Park Water District and Valley View Water District
currently DO NOT qualify for these rebates.
66 Applications must include a copy of a proof of purchase receipt from a retailer
or plumbing company that specifies the purchase date, purchase price,
manufacturer and model number.
66 The application must be received by TVWD within 90 days of purchase date.
66 Prior to approval, an on-site inspection will be required by TVWD to verify
installation.
66 The total rebate per item will not exceed the receipt amount.
66 Rebates are for newly purchased products and fixtures only. Pre-existing products, labor
and accessories (wax rings, seats, etc.) are not eligible.
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How To Apply
1. Call TVWD at (503) 848-3064 for preapproval of the rebate.
2. After purchasing and installing the materials for the project per the eligibility requirements outlined above, fill out
this rebate application form completely and attach a copy of the receipt or sales invoice.
3. Choose the most convenient option to submit the application and receipt:
Mail: TVWD, Attn: Rebates, 1850 SW 170th Ave, Beaverton OR, 97006
Fax: 503-356-3164
E-mail: [email protected]
TVWD will contact you within two weeks after we receive your rebate application to schedule
the project inspection.
Get answers to the most Frequently Asked Questions (FAQs) about rebates by visiting
www.tvwd.org or call 503-848-3064. Please allow 4-6 weeks for processing.
For more tax credit & rebate info visit: www.oregon.gov/ENERGY and www.energytrust.org
5/11
Download a QR scanner app on
your smartphone and take a picture
of our QR code for more information
Business, Industry, Government and Multi-Family
High-Efficiency Toilet & Flush Valve Rebate Application
Customer Information
̉̉ Own building
̉̉ Lease building
Company/Institution
Installation Address
Type of
Business
City
State
Zip
TVWD Account Number
Year building constructed/remodeled
̉̉ Office
̉̉ Institutional ̉̉ Food Service
̉̉ Multi-Family ̉̉ Production ̉̉ Other (Specify) _________ Property Owner
Contact Information
Check here if mailing address is same as installation address
Contact Name
Contact Title
Contact Phone
Mailing Address
Contact Fax
Contact E-mail
Toilet Rebate Information
WaterSense Labeled Tank-Type HETs
City
State
Zip
Check ̉̉ TVWD Account Holder
One
̉̉ Authorized Agent
WaterSense Labeled Urinals or Flush-Valve HETs*
Number Replaced
Cost Per Unit
Number Replaced
Cost Per Unit
Manufacturer
Model Number
Manufacturer
Model Number
Dealer/Branch
Date Purchased
Dealer/Branch
Date Purchased
Rebate(s) will be credited to your account. If you would like a check, please mark this box.
Check one: We will replace all our toilets at one time
We will replace our toilets in phases (attach work plan)
Would you like free water-efficient showerheads and faucet aerators? Showerhead # ______ Aerator # _______
Please contact me about a FREE water use assessment and recommendations for water savings.
*Flush Valve HETs are not currently labeled by the EPA WaterSense program, however they may still qualify for a rebate. Call 503-848-3064
before proceeding with a flush-valve HET rebate.
I certify the information I have provided is true and correct. I grant permission to Tualatin Valley Water District, with notification, to
enter upon the property to inspect and ensure program requirements are met. I understand rebates are distributed on a first-come
first-served basis until funds are distributed.
Signature
Date
Office Use Only
Approved
By
Date
5/11
Not Approved
By
Letter Sent