Newhall County Water District Application

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This program is sponsored by Newhall County Water District Mail to: Newhall County Water District ? P.O. Box 220970, Santa Clarita, CA 91322-0970 ? Attn: ET Controller Rebate Program Fax to: (661) 259-3574 Water Account Name Water Account # First Name Last Name Address City Zip Phone Number: Number ( ) E-Mail Address: Make check payable to: First Name Last Name Payee Phone: Number Social Security or Tax ID Number ( ) First Name Last Name Address Unit # City State Zip Contact Person: First Name Last Name Contact person is: (check one) Owner Tenant Day Phone: Number Alternate Phone: Area Code Number ( ) ( ) Best Time to Call E-mail Address Direct Mail Bill Insert NCWD Website Water Survey Other: __________________________________ I certify that the information on this application is true and correct. Customer Signature Print Name Date I acknowledge the installation costs covered by NCWD only includes the replacement of the existing timer/controller with a new ET Controller and Weather Station. The new ET Controller will be programmed once at the time of installation. Any additional work necessary to install the new ET Controller will be at your expense. 7. YOUR SIGNATURE Area Code 4. REBATE CHECK MAILING ADDRESS (If Different from Installation Address) 5. CONTACT INFORMATION Area Code Rebates are not guaranteed. Applications are processed in the order received. Rebates will be distributed on a first-come, first-served basis until funds set aside for this program are depleted. Please remember to enclose a copy of your most recent water bill with this Application. PLEASE NOTE: 1. ACCOUNT INFORMATION 6. HOW DID YOU HEAR ABOUT THE PROGRAM? 3. REBATE CHECK INFORMATION (Required!) Application Newhall County Water District All Applications are subject to a Water Audit by NCWD staff to determine eligibility. I acknowledge the installation costs covered by NCWD only includes replacing and programming my existing controller with the new ET Controller and weather station. Any additional work necessary to install the ET Controller will be at my expense. Number of current valves:_______ Number of valves for your new timer/controller will control:_______ Approx. irrigated landscape:_______ sq. ft. (1200 sq. ft. minimum) The rebate is $40.00 per active valve. The maximum amount for each rebate is $480.00 per residence, not to exceed the cost of the ET Controller. 2. SITE DATA (Installation Address) Area Code

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