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2019 Water Rebate YES NO I, certify that the above information is accurate. That I have read and conform to the program rules and qualifications. That the toilet and/or irrigation controller is installed and operational at this time. Qualification Checklist: Owner Phone Number and/or Email Address: Town of Monument water account Account is current Application is completed and signed Receipt is attached with this application New product purchase between 1/1/19 - 12/31/19 $50.00/ barrel Rain Barrel Rebate (max of 2 per address) Description: $50.00 Toilet Rebate Description: $100.00 Irrigation Controller Rebate Description: Item is installed at Town of Monument service address Application submittal Account Name: (as shown on bill) Installation Address: Site Contact - Name and Phone Number: Owner's Mailing Address: Account Number: Utility Billing [PHONE REDACTED] 645 Beacon Lite Road Monument, CO 80132 [EMAIL REDACTED]