Site Information 1/3

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The following information will be used to verify if the proposed site is eligible for participation in the program. 

1 - Site Name

2 - Did this site previously participate in a rebate program?

Which rebate program the site previously participated?

3 - Site Owner Name

4 - Site Owner E-mail

5 - Water Account #:

6 - Water Meter #:

7 - Site Address

Address Line 1

Address Line 2

City

State

Zip Code