Start At the Tap: Fixture Rebate Program

Name*
First Last
Name of Business
Physical Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone*
Type of Fixture #1*
Cost of Fixture #1*
Type of Fixture #2
Cost of Fixture #2
Type of Fixture #3
Cost of Fixture #3
Type of Fixture #4
Cost of Fixture #4
Type of Fixture #5
Cost of Fixture #5
Type of Fixture #6
Cost of Fixture #6
Type of Fixture #7
Cost of Fixture #7
Type of Fixture #8
Cost of Fixture #8
Type of Fixture #9
Cost of Fixture #9
Type of Fixture #10
Cost of Fixture #10
Total Amount of Rebate Requested*
Location Inspection*
- Yes, I agree to a location inspection.
Acknowledgement*
- l attest that the foregoing is true and correct to the best of my knowledge.
Please Upload Proof of Purchase*
Max. file size: 200 MB.
Please Upload Proof of Purchase
Max. file size: 200 MB.
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