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Enroll in Water Upgrades Save

Participant Information

Thank you for your interest in Water Upgrades Save. To get started, simply fill-in the application form below which only takes a minute or two. You will not need any utility account numbers to complete this form.

(A-03) First Name

(A-04) Last Name

(A-05) Your Address

(A-06) Address 2 (Apt, suite, unit, building, etc.)

(A-07) City

(A-08) State

(A-09) Zip Code

(A-10) Do you have a separate mailing address?

Yes No

(A-011) Your Mailing Address

(A-12) Address 2 (Apt, suite, unit, building, etc.)

(A-13) City

(A-14) State

(A-15) Zip Code

(A-16) Customer Phone Number

(A-17) Customer Email Address

(A-18) Do you rent or own the property you wish to enroll?

Renter Owner

(A-19) Company Name of Property Owner (if applicacable)

(A-20) Owner's First Name

(A-21) Owner's Last Name

(A-22) Phone

(A-23) Email

(A-24) What is your main motivator for enrolling in Water Upgrades Save?

(A-26) How did you learn about Water Upgrades Save?

(A-28) Consent to Collect and Use Personal Data
By submitting this form, you consent to the collection and use of the personal information you provide for the sole purpose of administering and delivering the program you are signing up for. Your information will not be used for marketing, shared with third parties, or retained beyond what is necessary to fulfill the program requirements, except as required by law.