WaterSmart Business rebate form

WaterSmart Business Rebates are now open.

I have read the Terms and Conditions of the Program *

Please ensure all information is provided, including supporting documents, as an incomplete application form will not be processed.

• Yes

Name *

ABN *

Barwon Water account number - if known

Mailing address *

Site address *

Contact name *

Position

Telephone

Mobile *

Email address *

Primary purpose of your business or community organisation

Product information

Type of product you are claiming *

Place(s) of purchase *

Item(s) replaced (make & model) *

Type of product/service (Tick all that apply) *

• Dual Flush Toilets*
• Waterless or Low Flow urinals*
• Showerheads
• Washing Machine (domestic/commercial)
• Dishwashers (domestic/commercial)
• Glass Washers
• Rainwater Tanks*
• Substitution of mains drinking water with alternate water sources such as groundwater or farm dams*
• Floor cleaner
• Pressure washer
• Drip irrigation
• Garden hose
• Irrigation controllers Wi-Fi
• Other

If you have selected 'other', please describe the product.

* May require installation by a licensed plumber or tradesperson

Have all permits/licences been obtained? *

• Yes
• No
• None required

If yes provide details

Have you consulted with a technical expert about the project? *

• Yes
• No
• None required

If yes provide details

Rebate

Total dollar ($) amount of your purchase(s), installation costs and delivery costs *

Rebate amount requested (max $1,500) *

Supporting documentation

Attach original invoice(s) which must include a clear description of the product purchased *

Attach original receipt(s) showing that the item(s) has been paid for in full *

Attach Plumbing Industry Commission (PIC) certificate of compliance if required

Attach photos of old fittings/fixtures and appliances

Attach evidence that the old appliance (washing machine, dishwasher or glasswasher) has been recycled

Attach photos of completed project *

Attach any additional information relevant to this claim

Payment details

Rebates will be processed via EFT, to receive a rebate please provide your bank account details.

Account name *

BSB *

Account number *

Declaration

I confirm that the details contained in this form are correct and current and notification of any changes to the information supplied will be made to Barwon Water in writing

Name *

Position *

Date *