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Water Efficiency Rebate Request

  1. Applicant Information

  2. Include area code with no dashes

  3. Property Type*

  4. Water Utility Information

  5. Rebates are only available to City of Apple Valley utility customers with non-delinquent accounts.

  6. Installation Information

    The City reserves the right to inspect the products for proper installation.

  7. Items Purchased*

  8. Information Required for Toilet, Washing Machine, Irrigation Controller Rebate

  9. must be purchased after January 1, 2020

  10. Information Required for Irrigation Audit Rebate

  11. Audit must be completed after Jan 1, 2020

  12. By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    Customer Agreement: My signature indicates that the information provided is true, I have read and understood the rebate program guidelines, and that I comply with the City of Apple Valley rebate program requirements. Upon compliance, a rebate will be distributed as a credit to my utility account if funding is available and my account is not delinquent at the time of application. I will allow a representative of the City of Apple Valley to verify the installation if requested.

  13. I agree*

  14. "First M. Last"

  15. Leave This Blank:

  16. This field is not part of the form submission.