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Rain Barrel Rebate Form

  1. Charlottesville water
  2. Put "Same" if your service address is the same as your mailing address.
  3. Please make sure the receipt number, vendor, date, amount, item, and quantity are all clearly visible.
  4. By checking each box you certify the following: *
    You must check ALL boxes to be considered eligible for this rebate.
  5. Electronic Signature- By adding your name here you agree that everything above is correct and submitted by you.
  6. Leave This Blank:

  7. This field is not part of the form submission.