Rev. 2/26/2018 Toilet Rebate Application Page 1
Durham Department of Water Management WaterSense® Toilet Rebate Application
The City of Durham is offering rebates valued at up to $100 per toilet when qualified water users replace existing high
water using toilets with EPA WaterSense® rated high efficiency toilet (HET) models.
IMPORTANT: Please allow 8 12 weeks for processing
APPLICANT INFORMATION (New toilets must be installed prior to submitting the application. Read all program rules on page 2.)
Name of Applicant
: _________________________________________________________________________________________________
Service Address (Street Address where toilet(s) are installed): _______________________________________________________________
Mailing Address (If different than above): ________________________________________________________________________________
City: ____________________________
State: ___________________
Zip: _______________________________
Daytime Phone #: ________________________________ Evening Phone #: _________________________________
Email Address: ___________________________________________________________________________________
PROPERTY AND ACCOUNT INFORMATION (Important Please mark the box that applies to you. Mark only ONE box.)
1. Property owner/occupant of service address noted above. My water account # is_________________________
2. Property owner/non-occupant of service address noted above with any active Durham water account.
Property owners with any active Durham water account, please enter an account # ________________________
3. Tenant
(Water account must be for service address and in tenant’s name).
My water account # is: __________________________
4. Property owner/non-occupant of service address noted above without any active Durham water account.
Property owners without an active Durham water account will have a rebate check mailed to the mailing address.
ADDITIONAL INFORMATION
How did you hear about the toilet rebate program?
(Please select one)
Mailer
Water Bill
City Website
City Staff Retailer/Plumber Newspaper Television Radio Other ________________________
Age of dwelling/building(s) or year built: ____________
Total number of toilets in the structure (s):_____________
Have you applied before? Yes No If yes, when did you apply?
Year:__________
TOILET INFORMATION
(Use a second application if you have replaced more than 3 toilets.)
Toilet
Old Toilet
Flush Volume*
New Toilet Manufacturer
New Toilet
Model Name
New Toilet
Model #
Install Date
New Toilet Installed By:
1
2
3
(*See page 2 for tips on determining toilet flush volume.)
Please confirm:
The ORIGINAL DATED SALES RECEIPT or INVOICE showing the price of each toilet, toilet model number, date, and store where purchased is attached.
(Photocopies are NOT accepted; supplying insufficient information may result in denial of application.) The purchase must have occurred within the last 12 months.
A COPY OF THE MOST CURRENT WATER BILL is attached (if the water bill is the responsibility of the applicant).
_______________________ Approved ___________ ___________ ________
Date Received Yes No # Approved Rebate
Verified by
Amount
Please read the paragraph below carefully before signing. If you do not fully understand each statement, please call (919) 560-4381,
or email toiletrebate@durhamnc.gov.
I have read, understand and agree to the terms and conditions of this rebate application as stated on page 2 of this application. I declare under
penalty of perjury of the laws of the State of North Carolina that all of the information provided herein is true to the best of my knowledge. I hereby
certify that I am the customer authorized to replace the toilets at the address listed above or the person who can authorize replacement has signed
below. This program does not guarantee the high efficiency toilet(s) performance or workmanship. I agree to a post-installation verification. The
toilet(s) being replaced will be destroyed or disabled before disposal. I am responsible for the high efficiency toilet(s) cost above the rebate amount,
NC sales tax and installation charges.
Applicant Signature _________________________________ Print Name____________________________ Date ______________
(Property Owner/Tenant)
Please mail ALL application materials to: Department of Water Management
Toilet Rebate Program
1600 Mist Lake Dr.
Durham, NC 27704
Application # ______________________
For Internal Use Only:
Rev. 2/26/2018 Toilet Rebate Application Page 2
Durham Department of Water Management WaterSense® Toilet Rebate Application
TO QUALIFY FOR A REBATE, THE FOLLOWING CRITERIA MUST BE MET:
1. The toilet must have been purchased within the last twelve (12) months prior to application submittal.
2. The purchased toilet(s) must be officially identified with the EPA WaterSense
®
label or can be verified.
3. High efficiency toilets (HETs) must be installed at the service address and must be installed prior to mailing the application.
4. The service address must be associated with a residential water account.
5. Applicant must have either an active Durham water account or own the structure(s) receiving water from the City of Durham.
6. An applicant will not receive any form of credit if the water account becomes inactive or property ownership changes within 45
days of submittal of a complete application package.
7. The total number of rebate credits may not exceed the total number of toilets in each structure of service address.
8. Toilets can be one piece (tank and bowl as one unit) or two pieces (tank and bowl) to be fitted together for a complete unit.
9. Each new toilet must replace an existing 1.6 gallons or greater per flush toilet. (Instructions on how to calculate the flush volume
of a current toilet are included with this application see below.)
10. Applicant agrees to not reuse, sell, or give away the old toilet(s) and must provide for proper disposal.
11. Applicant agrees to pay any and all sales tax, installation parts (eg. wax ring, bolts, flex hose, toilet seat), labor and building costs
associated with any HET installation.
REBATE INSTRUCTIONS: (Please allow 8 to 12 weeks for processing.)
1. Purchase and install qualifying WaterSense® rated high efficiency toilet(s). Note: The toilet(s) MUST be installed prior to submitting the
application for receipt of rebate credit(s). ANY INSTALLATION IS SUBJECT TO AN ONSITE VERIFICATION.
2. Complete, sign and date the other side of this application and submit it with a copy of current water bill (if applicable) and original dated sales
receipt(s) or invoices to the address at the bottom of page 1 of this application.
3. Once the rebate application is approved, rebate credit(s) will be applied to the water account number associated with the service address or to
the property owner’s City of Durham water account, whichever is applicable. If a property owner/non occupant” does not have an active City of
Durham water account to which the credit can be applied, a rebate check will be mailed to the mailing address listed on the application.
Property ownership will be verified through county tax records.
DO NOT SEND WATER BILL PAYMENT WITH THE APPLICATION!
TIPS TO DETERMINE GALLONS-PER-FLUSH VOLUME
1. Look for marks or labels near the toilet seat hinge. A 5-gallon per flush (gpf) toilet might be shown as 22.73 liters, a 3.5 gpf as 15.91 liters. All 1.6
gpf (6.1 liters) toilets should be marked at the toilet seat hinge. If no markings are present, check the underside of the tank lid or the tank’s back
inside wall for a date stamped in the porcelain. Toilets produced before 1985 are 5-7 gpf, a date between 1985 and 1991 would be 3.5 gpf. All
toilets made after 1993 are 1.6 gpf.
2. There are two ways to conduct a Toilet Water Use Test. The most accurate way is by measuring the tank.
a. Measure the length of the tank in inches.
b. Measure the width of the tank in inches.
c. Measure the full water level in the toilet tank in inches (depth 1).
d. Flush the toilet and measure the drop at the lowest level (depth 2).
e. Subtract depth 2 from depth 1. This will give you the “drop” measurement.
f. Multiply the length times the width times the “drop” to determine the volume of cubic inches of water used per flush.
g. Divide the volume by 231 to get the number of gallons per flush
REBATE AMOUNT
The value of the high efficiency toilet rebate is the cost of each toilet up to $100, per toilet, and may cover the entire retail cost of an HET if the total cost
does not exceed the total value of the rebate. High efficiency toilet purchase costs that exceed the rebate value are not covered under this program. Any
high efficiency toilet cost that exceeds the rebate value is to be paid by the applicant and is the sole responsibility of the applicant.
VERIFICATION OF INSTALLATION
The City of Durham reserves the right to inspect to verify the installation of the new HET model(s) submitted for this rebate program, and if contacted, you
agree to allow for a post-installation inspection. Inspections will be scheduled between the hours of 8:30 a.m. and 4:00 p.m., Monday through Friday.
DURATION
Applications will be accepted on a first come, first served basis, only while funding is available, or until the program is discontinued. The City of Durham, in
its discretion, may, at any time modify, suspend, or terminate this program without prior notice.
Disclaimers: The City of Durham reserves the right to reject any application that does not meet all of the requirements of this rebate program. The City of
Durham makes no representations or warranties as to the condition, quality, effectiveness, operability or cost of installing or maintaining a high efficiency
toilet subject to this program, or removing or disposing of a low efficiency toilet, associated parts, building materials, labor and equipment in connection
therewith and, to the extent not prohibited by law, disclaims all express and implied conditions, representations and warranties related thereto, including
without limitation, any implied warranty of merchantability or fitness for a particular purpose.
Limitation of Liability/Release: Applicant understands and agrees that, to the extent not prohibited by law, in no event shall the City of Durham, its
officials, officers, employees or agents be liable for any claimed or actual damages or losses of any kind, however caused and regardless of the theory of
liability, related in any way to this rebate incentive program, even if the City of Durham has been advised of the possibility of such damages or losses. To
the extent not prohibited by law, applicant assumes all risks associated with this program, including without limitation, all risks associated with purchase,
installation and maintenance of an HET model subject to this program (including without limitation the risk of not realizing cost savings as a result of
converting to a high efficiency toilet model), and the removal and disposal of old toilets, associated parts, building materials, labor and equipment in
connection therewith. Applicant releases the City of Durham, its officials, officers, employees and agents from any and all claims for damage or death or
injury to any persons or property arising in any way from this rebate program, including the installation of an HET, associated parts, building materials,
labor and equipment subject to this program (including without limitation the use or operation thereof), or the removal or disposal of any toilet, associated
parts, building materials, labor and equipment in connection therewith, other than those caused solely by the willful or grossly negligent acts or omission of
the City of Durham.