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Spray-to-Drip Irrigation Commercial Rebate Application

Thank you for participating in the Spray-to-Drip Irrigation Conversion Program. Please complete the following application.

Contact Information

1. Who is completing this application *This question is required.

2. Retail Water Agency *This question is required.

3. Confirm Retail Water Agency *This question is required.

4. Is this site part of MWDOC's Public Spaces Program

5. Name on Water Bill *This question is required.

6. Water Bill Account Number *This question is required.

Acct. No. 1
Acct. No. 2
Acct. No. 3
Acct. No. 4
Acct. No. 5

7. Please upload a copy of your water bill.
(Tips: It does not need to be your most recent water bill. Contact your local water agency if you need a copy.)
Don't forget to press UPLOAD. *This question is required.

File: {{filename}} delete

8. Project Location *This question is required.

Site Name

Project Location Description or Assessor's Parcel Number (optional)

Street Number

Street Name

City

Zip

9. Who is the primary contact for this project? *This question is required.

10. Contact Information for Property Owner/Manager *This question is required.

First Name
(NoSpaces)

Last Name
(NoSpaces)

Email Address (if possible, please avoid using aol.com email addresses as they are not compatible with our system) This question requires a valid email address.

Area Code
(xxx)

Phone Number
(xxx-xxxx)

Alt. Area Code
(xxx)

Alt. Phone Number
(xxx-xxxx)

This person is the:

Please enter an 'other' value for this selection.

11. Contact Information for Contractor/Vendor/Installer

Company Name