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2015 Water Rebate YES NO Town of Monument water account Account is current Application is completed and signed Receipt is attached with this application New product purchase between 1/1/15 - 12/31/15 $50.00 Toilet Rebate Description: $100.00 Irrigation Controller Rebate Description: Item is installed at Town of Monument service adddress Application submittal 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. Owner Phone Number and/or Email Address: Account Name: (as shown on bill) Installation Address: Site Contact - Name and Phone Number: Owner's Mailing Address: Account Number: Qualification Checklist: 645 Beacon Lite Road Monument, CO 80132