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Efficient Flush Rebate Form

After Replacing Your Old Inefficient Toilet:

★ Fill out the form below.
★ Attach copies of your efficient toilet purchase/s and toilet installation costs.
★ Click “Submit.”

Rebate Information

First Name *

Last Name *

Business name (if applicable)

Street address *

City *

State *

ZIP *

Phone number

Email *

Rental *

Yes (If yes, fill out the information below)

No

Property Owner Information

Owners Name

Owner street address (where rebate check will be sent)

Owner city

Owner state

Owner ZIP

Toilet Replacement Information

Customer type *

Residential

Commercial

Number of toilets replaced *

Estimated year of toilet or GPF (if toilets have different years or GPF, please list) *

Toilet information can be found under the tank lid, on the interior walls of the tank, or at the base of the toilet.

New toilet model # (list all model numbers, if different) *

Toilet information can be found under the tank lid, on the interior walls of the tank, or at the base of the toilet.

Total cost *

The total installation cost should include the price of a qualifying toilet tank, bowl, installation hardware, wax ring, and installation cost incurred by a licensed plumber.

Estimated total rebate amount *

Residential: Rebates up to $75 per toilet or 50% of the materials and installation costs, whichever is less. Maximum of two toilets per address.
Commercial: Rebates up to $100 per toilet or 50% of the materials and installation costs, whichever is less. If you would like to replace more than four toilets, a pre-installation inspection with Water & Light will be required.

Attach receipts (or show documentation at installation verification appointment)

Please attach the following: documentation of total costs, documentation showing the toilet is WaterSense Certified or has a 1.28 GPF rating or less. The total installation cost should include the price of a qualifying toilet tank, bowl, installation hardware, wax ring, and installation cost incurred by a licensed plumber.

Customer Agreement

I acknowledge that the City of Columbia is no way responsible for the condition of the plumbing on the downstream side of the water meter, now and or in the future. The rebate application form and receipts must be submitted to Columbia Water & Light within six months of the toilet installation. Incomplete or incorrect application will have 30 days to provide the correct information or risk losing their rebate. To properly dispose of toilet please call the Contact Center at 573.874.CITY(2489). Ask for Solid Waste to receive the proper procedures.
I understand that the application for a rebate is subject to Columbia Water & Light rules and procedures, which are subject to change without notice. I certify the above declaration is true, accurate and complete. One-time rebates are available for qualifying water customers. Rebates are offered on a first-come, first-served basis as funding is available each fiscal year.

Customer signature (sign by typing name) *

Date *

Captcha *

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Questions?

Contact Utility Services at 573-441-5528 or email us at Info@ColumbiaPowerPartners.comcreate new email.

Efficient Flush Rebate Form

Questions?

Contact Utility Services

Address

Phone

Email