Smart Irrigation Controller Retrofit Rebate Application

2. Rebate Information
   **WAIT LIST** <br> Funds are exhausted for 2020. Filling out this application will put you on a wait list should more funds become available.<BR> <BR> The Smart Irrigation Controller rebate is intended to replace or upgrade old controllers with new, weather-based technology. This rebate is offered one-time per account and must be installed in the Town's water service area.

   **WAIT LIST**
   Funds are exhausted for 2020. Filling out this application will put you on a wait list should more funds become available.
   
   The Smart Irrigation Controller rebate is intended to replace or upgrade old controllers with new, weather-based technology. This rebate is offered one-time per account and must be installed in the Town's water service area.

4. 1. Account Information

6. Water Account Name*

7. Water Account Number

9. Date Attended Water Wiser Workshop

   Qualified applicants are required to attend a Water Wiser Workshop.

10. Photo Identification

    Please attach a copy of your photo identification. Refer to the Affidavit of Lawful Presence for acceptable forms of identification.

14. 2. Installation Data

16. Address*

18. City*

19. State*

20. Zip Code*

24. 3. Contact Information

26. Contact Person*

27. Last Name*

29. Phone Number

30. Best Time to Call

32. Email Address

36. 4. "Old" Traditional Controller Being Replaced
    To be eligible for a rebate, you are required to bring in the traditional controller that was replaced as part of the application. The old controller will be recycled by the Town of Castle Rock.

    To be eligible for a rebate, you are required to bring in the traditional controller that was replaced as part of the application. The old controller will be recycled by the Town of Castle Rock.

38. Manufacturer / Make*

39. Model Number*

43. 5. "New" Smart Irrigation Controller Information
    The smart irrigation controller must be installed on a fully operational automatic irrigation system, must be new and meet qualifying criteria. Actual water savings may vary.

    The smart irrigation controller must be installed on a fully operational automatic irrigation system, must be new and meet qualifying criteria. Actual water savings may vary.

45. Manufacturer / Make*

46. Model Number*

47. Date Purchased*

49. Where Purchased*

50. Location*

    (City)

51. Attach Copy of Original Receipt

53. Submittal Information
    Submittal of the online application is not considered complete until the AFFIDAVIT OF LAWFUL PRESENCE is signed and returned by the applicant. Once you choose "submit" you will receive a confirmation and affidavit. Please print the affidavit and return to the Program Administrator. Your rebate cannot be processed without this signed affidavit. Complete, rebate applications will be processed in the order of receipt. Rebate checks are issued within three to six weeks after receipt of a completed application.

    Submittal of the online application is not considered complete until the AFFIDAVIT OF LAWFUL PRESENCE is signed and returned by the applicant. Once you choose "submit" you will receive a confirmation and affidavit. Please print the affidavit and return to the Program Administrator. Your rebate cannot be processed without this signed affidavit. Complete, rebate applications will be processed in the order of receipt. Rebate checks are issued within three to six weeks after receipt of a completed application.

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55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit

* indicates a required field