Participant Agreement
The water-efficient product(s) marked above have been installed at the Azusa location
indicated. I have attached a copy of the itemized proof of purchase sales or paid invoice
other required documentation. I understand that falsifying information may lead to my
disqualification from this incentive program and that Azusa Light & Water will take
appropriate actions to recover the rebate amount. Funding is limited and this program is
subject to change or cancellation without prior notice. I have read and agree to these
terms and to verification of installation by an Azusa Light & Water representative, or
contracted third party, as necessary.
I further understand that all residential rebates will be applied as a credit to my water
utility account on or after the next billing cycle. Commercial/Industrial/Institutional
rebates will be issued as a check.
NOTE: If your rebate amount is $600 or more you will receive a 1099 form to comply
with Internal Revenue Service requirements. The determination of whether your rebate is
taxable or not may depend on several variables. You are recommended to contact your
tax professional.
Customer Signature ______________________________ Date ____________________
If you have any questions, contact us at 626-812-5225 or rebates@azusaca.gov. Go to
our website at www.azusalw.com for up-to-date rebate requirements and qualifications.
Mail or Hand Deliver Application to:
Azusa Light & Water
729 N. Azusa Avenue, Azusa, CA 91702
Attention: Water Rebate Program
Note: City of Azusa permits may be required for work done in the City of Azusa. Permits
may be obtained from the Building Division. You may contact them at 626-812-5234 for
related questions.
Modified: 07-22-19
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