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Middleton Water Utility Water Efficiency Audit Commercial Application Form Please read all program rules before submitting. The rules can be found at www.cityofmiddleton.us/waterconservation. Applicant Information Name (please print) Business Address Unit Number Account # Mailing Address (if different) Mailing Address City State Zip Telephone Email Address Preferred method of contact o Mailing o Telephone oEmail Water Audit Information Please describe the water efficiency audit that will be undertaken. Please include the auditors’ name/business name, address, and telephone number. Post Water Audit If all of the recommended water savings measures were undertaken, what is the total number of estimated annual gallons saved? Water Audit Agreement o I have read, understand, and agree to the terms and conditions in the water conservation program description. I understand that the Middleton Water Utility will reimburse 50% of the costs of the water audit upon receipt of this form along with proof of payment for the audit. I understand that the Middleton Water Utility will only earmark funds for this water efficiency audit for 60 days following the acceptance of this form. Please wait to hear from the Water Utility for formal acceptance of this form prior to beginning the audit. After 60 days, the funds are released and made available to other commercial customers. Funding for this program is allocated annually. Audit reimbursements available while funding lasts. Applicant Signature Date Mail your completed application form and your original dated receipt and proof of audit payment to: Middleton Water Utility, Water Conservation Rebate Program, 7426 Hubbard Avenue, Middleton, WI 53562. Questions? (608) 821-8370