Smart Irrigation Controller Rebate Online Form

You may complete the form below, or fill out the following PDF application and mail or fax it to our office at the numbers provided: PDF Application

 

ACCOUNT INFORMATION
Water Agency: Water Account #:
CUSTOMER INFORMATION (INSTALLATION ADDRESS)
*First Name: *Last Name:
*Address:
*City: *State:   *Zip:    
*Home Phone: *Daytime Phone:
*Email Address: *Property Type: Residential Commercial
*Number of active valves/zones *4 valve/zone minimum:  
*Irrigated Landscape Area (in sq. feet) *2,000 square foot minimum:  
WEATHER BASED IRRIGATION CONTROLLER INFORMATION
*Date Purchased:   *Date Installed:  
Dealer Name:   Dealer Location:  
*Manufacturer:   *Model Number:  
*Controller Cost (w/out sales tax):   *Model name:  
*Weather Sensor Cost (w/out sales tax):   *Number of Zones:  
REBATE CHECK INFORMATION
Make check payable to:
*First Name: *Last Name:
*Address:
*City: *State:   *Zip:  
*Payee Phone: Other Phone:
If payee name is other than account holder, please explain:
CONTACT INFORMATION
(if different from Customer Information)      
First Name: Last Name:  
Contact Person is: Owner Other   (please explain): 
Daytime Phone: Other Phone:  
Email Address: Best time to call:  
SIGNATURE AND VERIFICATION

I have read, understand, and agree to the Terms and Conditions of the Rebate Program attached to this application. I certify under penalty of perjury that the information on this Application is true and correct.
*By checking this box, you agree to the above Terms and Conditions.
*Full Name:
Today's Date:
HOW DID YOU HEAR ABOUT THIS PROGRAM?
Direct Mail Bill Insert Newspaper Ad Website Other
DISCLAIMER
Casitas MWD does not warrant or assume any liability for the design, manufacture, installation or operation of any irrigation controller obtained under this program.
*Please enter the code shown: CAPTCHA Image