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Residential Toilet Rebate Form

The Township of Centre Wellington is offering a $75 rebate (including HST) to residents and small businesses for the replacement of an inefficient toilet with a more water efficient model as approved by the Township. This Program is effective October 28, 2024.

The following criteria must be met by the resident / business to become eligible:

meet and agree to the terms and conditions of the Township's Toilet Rebate Program;
be connected to the municipal water and sanitary sewer system and receive a water bill;
purchase and install a low-flow toilet as approved by the Township of Centre Wellington and compliant with O. Reg 332/12: Building Code;
replace a toilet with a flush volume greater than 6 litres with a WaterSense® certified toilet;
fill out this application form and submit it with a copy of original sales receipt(s) for the new toilet(s), and a photo of either the serial number or the flow rate of the inefficient toilet(s) being replaced; and
be available for an on-site inspection of the newly installed efficient toilet(s).

Please note: at this time, the program only applies to residential, instituitional, and small commercial properties. For industrial, large commercial, and multi-unit residential properties, please contact the Township Water Conservation Coordinator for current/future eligibility.

Applicant Name:

Address

Postal Code

Phone Number

Email Address

x $75.00 per rebate = $

New Toilet Information

Toilet(s) Installed by:

Plumber

Self

Is this your first time applying for this rebate?:

Yes

Toilet 1 Make:

Toilet 2 Make:

Toilet Model #:

Purchased Store:

Date Purchased:

Total Cost (pre-tax) $

Old Toilet Information

Known or Estimated Flush Capacity

Model/Serial # OR Manufacture Date (if found)

Upload Images of receipt and old toilet serial # -or- flow volume here:

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Any Additional Information/Notes for Application

By submitting an application, the applicant agrees to release, waive and forever discharge the Township of Centre Wellington of and from all claims, actions, causes of action, losses, damages, expenses and costs of any nature whatsoever arising out of or related to the applicant’s participation in the program. The applicant further acknowledges that the Township is not responsible for the selection of and does not warrant the performance of or accept any liability for the operation or non-operation or manner or form of installation of the toilet replacement equipment under this program.

I have read, understand, and agree to the terms and conditions of the Township's Toilet Rebate Program.

Applicant Signature

Clear

Date

Please submit this application online through the Township website, or drop off completed form at the Centre Wellington Infrastructure Office; 7444 Wellington County Rd 21, Elora, ON N0B 1S0.

On this form, personal information, as defined in section 2 of the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA), is collected under the authority of the Municipal Act, 2001, and in accordance with the provisions of MFIPPA. Questions about the collection of this information should be directed to the Clerk’s Office: 519-846-9691, ext. 243.