High-Efficiency Toilet Rebate Application

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Apply for a High-Efficiency Toilet Rebate

Apply for a $75 per toilet rebate when you replace your old water-wasting toilet(s) with an EPA WaterSense labeled 1.28 gallons per flush High-Efficiency Toilet(s).
Limit: 2 High-Efficiency Toilet rebates per household.


1

I live in a single-family residence within the Hillsboro Water Department service area with a single or master meter. This includes houses, condominiums, duplex/multiplex residences and manufactured homes. 
Note: Apartment owners and residences supplied by our wholesale customers currently DO NOT qualify for these rebates.

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I live in a single-family residence within the Hillsboro Water Department service area with a single or master meter. This includes houses, condominiums, duplex/multiplex residences and manufactured homes. Note: Apartment owners and residences supplied by our wholesale customers currently DO NOT qualify for these rebates.
2

I am the point of contact on the Hillsboro Water account.

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I am the point of contact on the Hillsboro Water account.
3
I have a current Hillsboro water account that is not past due. 
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I have a current Hillsboro water account that is not past due.
4

In the last 90 days, have you replaced an old water-wasting toilet by purchasing and installing an EPA WaterSense labeled 1.28 gallons per flush High-Efficiency Toilet?

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In the last 90 days, have you replaced an old water-wasting toilet by purchasing and installing an EPA WaterSense labeled 1.28 gallons per flush High-Efficiency Toilet?

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Customer Information
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Customer Information
6
Please select the residence type and enter the name of the property (if applicable).
Please select the residence type and enter the name of the property (if applicable).
7

High-Efficiency Toilet 1 Information*

*Note: The toilet must be labeled as an EPA WaterSense 1.28 gallons per flush model.

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High-Efficiency Toilet 1 Information* *Note: The toilet must be labeled as an EPA WaterSense 1.28 gallons per flush model.
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High-Efficiency Toilet 2 Information* (Optional)

*Note: The toilet must be labeled as an EPA WaterSense 1.28 gallons per flush model.

High-Efficiency Toilet 2 Information* (Optional) *Note: The toilet must be labeled as an EPA WaterSense 1.28 gallons per flush model.

Applications must include a copy of a proof of purchase receipt from a retailer or plumbing company that specifies the purchaser’s name, purchase date, purchase price, manufacturer and model number. 


Please email a copy of your receipt to Simon.Christensen@Hillsboro-Oregon.gov.


If you are unable to email the receipt, you may send it by mail with a copy of this form.

After you submit this online form, you will receive a copy of the form via email.


Please print the email and send it along with your proof of purchase to: 

 

Hillsboro Water
Attn: Rebates
150 East Main Street
Hillsboro, OR 97123


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Check List
Check List

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 I certify the information I have provided is true and correct, and I have purchased the products for use at the location indicated. I grant permission to Hillsboro Water Department, with notification, to enter upon the property to inspect the installation of rebate products to assure program requirements are met. I understand rebates are distributed on a first‐come first‐served basis until all funds are distributed, and may be discontinued at any time without notice. I have read and understand the terms and conditions of the Hillsboro Water Rebate program, and have checked Hillsboro's Water Efficiency Rebates page for any program updates.
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11
Electronic Signature
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Electronic Signature
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