OUTDOOR REBATE CERTIFICATION FORM

Customer InformationApplicant is a customer on the Water Authority's water system, owns property, or acts as the owner's agent at the installation address.

Date: Account Number:

Customer Name:

Installation Address:

Daytime Phone: Alternate Phone:

Attention Customers: This form will NOT be processed unless all information areas are completed and all receipts are included with the form.

Rev 11.9.16 AMP

FOR OFFICIAL USE ONLY

Processed by: Date Processed: Credit Amount:

Verified by: Date Verified: Sup's Approval:

Comments:

Service or Purchase Information Company or Store Name:

Purchase Price or Service Amount: Purchase or Service Date:

Multi-setting Sprinkler Controller (25% Off Purchase Price Rebates) Rain Barrel Harvesting Rebates are based upon the amount of rain water that can be stored. Select the gallon capacity below.

Grass Removal Rental Equipment -Xeriscape Rebate participants only (25% Off Purchase Price) 50-149 gallon ($25) 150-299 gallon ($50)

Compost (25% Off Purchase Price) (Xeriscape Rebate participants only) 300-499 gallon ($75) 500-999 gallon ($100)

Multi-stream Rotor Sprinkler Heads ($2/head) List # of Heads: 1000-1499 gallon ($125) 1500 and over ($150)

Rain Sensor ($25) Pressure Regulation Valve ($25) Pressure Vacuum Break ($25) Backflow Prevention Valve ($25)

Tree-Bate - List the purchased tree(s) or the maintenance performed:

Program Requirement Information Please complete and return this form with proof of purchase or service with attachments to ABCWUA - Water Conservation Program,

P.O. Box 568, Albuquerque, NM 87103 or E-mail to rebates@abcwua.org. 1. Applicants are required to be a Water Authority (WA) customer. 2. The customer is solely responsible for the purchase, installation arrangements, and payments. 3. The Water Authority does not warrant, endorse, or assume liability for the quality or performance of the product related to

purchases under this program. 4. If selected, the customer agrees to allow a qualified WA personnel to access to the premises to verify installation. 5. Rebate credits remain at the address where the conservation work took place. Customer may not transfer the credit from the

location of the savings to another WA account, even if both properties are owned by the same person. 6. The rebate form is required to be returned to the WA within ninety (90) days of the purchase or service date to be honored. 7. Rebate credits the service address account and appears on the bill within one to two billing cycles after form processing. 8. Customers are required to submit proof of purchase or service with the rebate form. If missing proof of purchase or service or the

rebate form is incomplete, it delays processing and documentation is returned to the customer. 9. Only customers who participate in the Xeriscape Incentive Program may apply for the Rental Equipment and Compost Rebates. 10. Rain barrel's minimum size is 50 gallons with no limits on the amount of rain barrel rebates. 11. The customer may qualify for 25% off the purchase price of qualified xeric trees or tree care, up to $100 per residential or $500 per

non-residential accounts. Covered items include: professional tree servicing and fertilization, irrigation equipment, soil amendment for new trees, or the purchasing of qualified xeric trees. Tree-Bates are not available for the removal of trees.

By signing this form, the customer has read and accepts the requirements and conditions of the Water Authority's Rebate Program. I declare under penalty of perjury under the laws of the United States of America that the foregoing is true and correct, and that I am the person named above, and I understand that any falsification of this form may result in the refund of the rebate.

Customer Signature:

Date: