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Dishwasher Rebate Program Application

Applicant Information

Installation Address

Water Bill Account Information

Dishwasher Device Information

Old Device:

New Device:

How did you hear about this rebate?

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Acknowledgement of Terms and Conditions

By clicking the submit button below, I hereby agree to and accept the following Terms and Conditions.

Please fill in all required fields

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If you have any questions or issues, please contact Green Media Creations at (888) 274-2167.

If you would like to speak to a West Basin representative, please contact Jenyffer Vasquez at JenyfferV@westbasin.org.

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Partners:

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Please visit our Resources page for additional assistance with installations.