Receive your qualifying rebate(s) faster when you apply online!

Before you begin, please make sure you have reviewed the Water Conservation Rebate Program Guidelines for the rebate(s) you intend to apply for. If you have any questions, please contact the City of Madera's Water Conservation Department at (559) 661-5466.

Which rebates are you applying for today?

Please check all that apply:

Clothes Washer ($200 Maximum)Dishwasher ($200 Maximum)Low-Flow Toilet ($100 Maximum)+Low-Flow Toilet Installation ($100 Maximum)Mulch ($100 Maximum)+Mulch Delivery ($75 Maximum)Smart Irrigation Controllers ($200 Maximum)Drip Irrigation ($150 Maximum)Hose Faucet Timer ($50 Maximum)Hose Bib Lock ($20/ea.)Rain Barrel (85% of cost up to $400)

Please attach proof of purchase (itemized receipts/invoices)

Attachment 1*

Attachment 2

Attachment 3

Attachment 4

Attachment 5

*Only JPG and PDF file types can be uploaded. At least one file attachment is required for processing.

Account Holder Information

City of Madera Utility Billing Account # (required)

Account Name (required)

Account Address (required)

Zip (required)

Telephone (required)

Alternate Telephone

E-mail (required)

ATTENTION RENTERS, TENANTS, AND CONTRACTORS:

Participation requires written approval from property owner and/or property manager. A letter of approval must be attached and submitted with your completed application. If this does not apply to you, please skip this section of the application.

Property Owner (if different from above)

Mailing Address

Zip

Telephone

Alternate Telephone

E-mail

Building Type (please select the one that matches your installation address)

—Please choose an option—CondoHOA Shared Billing AccountMobile HomeMulti-Family Apt/DuplexPUDSingle Family Home

Rebate Information

How did you learn about this rebate?

Would you have purchased water conserving products at this time if this rebate was not being offered?
—Please choose an option—YesNoN/A

Is this a replacement for existing equipment?
—Please choose an option—YesNo

Inspection & Documentation

INSPECTION: If an on-site compliance inspection of the installed new product or appliance is required, you will be notified in advance.

DOCUMENTATION: To receive rebate, residential customer must purchase and install product, or appliance in compliance with Rebate Program Guidelines and Conditions.

• Rebate value may not exceed the actual cost of product or appliance
• Application must be received within 60 days of purchase and installation of rebate product or appliance
• Copy of original dated itemized sales purchase receipt must be attached to application for Rebate approval.
• Compliance with Rebate Program Guidelines and Conditions is required.
• Application must be approved prior to rebate. Incomplete applications will be returned.

Agreement of Terms & Conditions

The City of Madera may deny any application that does not meet program requirements which can be obtained by calling (559) 661-5466. The undersigned expressly agrees that the City may inspect all items submitted for the City of Madera Rebate Program; that the City does not guarantee the performance of any rebate equipment; and that the City does not warrant any rebate equipment or installation to be free of defects, the quality of the workmanship, or the suitability of the premises or the rebate equipment installation, and upon installation attests they will continue to use and maintain the equipment. The applicant further acknowledges that if their property is found without the rebate equipment or system installed, the rebate credit will be forfeited and a penalty equal to the amount of the rebate will be assessed to the account. The undersigned further agrees to hold harmless the City of Madera against all loss, damage, expense and liability resulting from the loss, destruction or damage to property arising out of or in any way connected with installation of any rebate equipment. The City reserves the right to alter this program at any time without prior notice. Funding for this rebate program is limited to available resources. Rebates are processed on a first come, first served basis. By using this form you agree with the storage and handling of your data by this website.

I, , have read, understand, and agree to the terms and conditions of this rebate program.