Rotary Nozzle Retrofit Rebate Application

2. Rebate Information
   The Rotary Nozzle Retrofit rebate is offered one-time per service location. This rebate specifically targets the replacement of less efficient, traditional fixed or adjustable arc spray nozzles with more efficient rotary nozzles. In most cases, the retrofit can be accomplished by simply removing the old spray nozzle and replacing with the new rotary nozzle. Generally, replacement of the entire sprinkler head is not necessary. Rebate is for the purchase price of the nozzle (excluding installation costs, taxes, shipping/handling) up to $5 each. Non-residential max. is $2,000. These water conserving nozzles are recommended in conjunction with a 6-inch pop-up height sprinkler head for turf areas, and a 12-inch pop-up height for native areas. Actual water savings may vary.
4. 1. Account Information
6. Water Account Name*
7. Water Account Number
9. Date attended 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. First Name*
17. Last Name*
19. Address*
21. City*
22. State*
23. Zip Code*
25. Building Type*

    1. Residential

    1. Non-residential
29. 3. Contact Information
31. Contact Person*
32. Last Name*
34. Phone Number
35. Best Time to Call
37. Email Address
41. 4. Rotary Nozzle Information
    To be eligible for a rebate, you are required to bring in all of the nozzles that were replaced as part of the application. The old nozzles will be recycled by the Town of Castle Rock. Rotary nozzles must be installed in the Town's water service area, during the current rebate year. Actual water savings may vary.
43. Manufacturer / Make*
44. Model Number*
45. Date Purchased*
47. Quantity*
48. Purchase Price*
49. Attach a Copy of Original Sales Receipt
53. Manufacturer / Make
54. Model Number
55. Date Purchased
57. Quantity
58. Purchase Price
59. Attach a Copy of Original Sales Receipt
63. 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.
65. Email Address
    This field is not part of the form submission.
Leave This Blank:


67. 1. Receive an email copy of this form.
68. Email address

    This field is not part of the form submission.

69. Submit

* indicates a required field