Mail to: Toilet Rebate Program, 135 Keyes Rd., Concord, MA 01742
Page 1 of 2
Water and Sewer Division
FY2020 High-Efficiency Toilet (HET) Rebate Application - $100
Please make sure you read both pages of this application carefully, fill out completely, and sign the bottom of page 2.
Customer Information as appears on water bill
Telephone: (day)__________________________________
(evening): _______________________________________
Service address:____________________________________
Account number (from water bill):______________________
Email address:______________________________________
Number of toilets at this address:___________________
Number of rebates requested:______________________
In-ground irrigation at this property? Yes ____ No ____
Replaced toilet make, model, gal/flush (find inside tank
or where seat attaches to bowl OR submit a photo)
*Please do not leave blank!*
#1 __________________________________________
#2 __________________________________________
How did you hear about this program? Plumber:____ Concord Journal:____ Water bill: _____
Water Quality Report:_____ Website:_____ Other:____________________________________
High-Efficiency Toilet (HET) Replacement
Please enter all the information below.
Manufacturer/Brand Model Name Model Number
The rebate is $100 or the cost of the toilet, whichever is less, when replacing a 3.5 gal/flush (or greater) model
with a WaterSense labeled HET (≤ 1.28 gal/flush). A list of qualifying toilets can be viewed on EPA’s
WaterSense website (web search: WaterSense Product Search).
Rebate Process (Limit 2 HET rebates per account)
1. Purchase a WaterSense® labeled High Efficiency Toilet.
2. Document make, model, gal/flush of existing toilet OR take and submit photo(s) prior to disposal.
2. Install the new toilet.
3. Submit the following information:
Completed application form
Unaltered, dated sales receipt and/or clearly itemized invoice. A copy is sufficient.
4. The rebate will appear as a credit on your water bill within 1-2 billing cycles once fully completed
application and supporting information is received. B
For Town Use Only Application Number ________
Inspection: _____ Yes ______Waived Application: _____ Approved _____ Denied (reason):__________________________
Mail to: Toilet Rebate Program, 135 Keyes Rd., Concord, MA 01742
Page 2 of 2
Water and Sewer Division
FY2020 High-Efficiency Toilet (HET) Rebate Application - $100
The rebate for a HET using ≤1.28 gal/flush or a dual flush toilet using ≤1.6/1.1 gallons per full or
solid/reduced or liquid flush that replaces a ≥3.5 gallon/flush model is a $100 credit to your water bill.
The rebate offer is on a first-come, first-serve basis and is effective from July 1, 2019 – June 30, 2020 or
until funding is exhausted.
Make, model, and/or gallons per flush of the replaced toilet must be included for an application to be
considered complete. If the applicant is unable to determine these identifying characteristics, it is suggested
that a photo of the replaced toilet be submitted or that the replaced toilet be kept on site for evaluation by
Water and Sewer Staff to determine eligibility.
Toilets must be purchased between July 1, 2019 and June 30, 2020 to be eligible for rebate.
All applications must be received by June 30, 2020 to be eligible for rebate.
Limit 2 HET toilet rebates per household.
Applications must be post-marked within 90 days of toilet purchase.
An unaltered, dated sales receipt and/or clearly itemized invoice listing the toilet make and model
number MUST accompany this application. A copy is sufficient.
Rebates are available to residential and commercial Concord Water customers. Applicant must be the owner
of the property listed on the rebate application.
Old toilets cannot be reused.
Applicant is responsible for verifying that the unit is on the WaterSense labeled product list.
New construction projects and remodeling projects requiring a building permit do not qualify for rebates.
Applicant agrees and understands that CPW does not guarantee that the installation of a
new toilet will result in water savings, as site-specific water consumption varies.
CPW does not warrant, endorse, or assume liability for the quality, performance, or safety
of the contractor and/or retailer or wholesaler, or performance of any appliance or fixture.
For performance ratings on participating HETs by manufacturer and model number, you
can visit the Maximum Performance (MaP) testing website at
Applicant agrees to hold harmless CPW, its commissioners and employees against loss,
damage, expense and liability resulting from the loss, destruction or damage to property
arising out of or in any way connected with the installation of a toilet.
Applicant agrees and understands that the program may be discontinued and/or the rebate dollar amounts
may be changed due to the actions of the Concord Public Works Commission or the exhaustion of program
funding, at any time, without further notification to customers possessing outstanding applications.
Applicant agrees and understands that CPW or its representatives reserve the right to inspect the installation
of the fixture before or after the rebate credit is applied to the applicant's water bill.
Applicant understands that CPW may withhold rebate until any or all of the above listed conditions are met.
By signing and submitting this rebate application, you agree to allow a post-installation inspection by Water
and Sewer Staff during normal business hours, if requested.
I have read, understand, and agree to the terms and conditions of this rebate program.
_____________________________________________________ ______________________
Signature of applicant Date
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