Utilities Alt Water Rebate form

Information About Alternate Water Source Rebate

We will confirm your eligibility by either phone or email

	Your Name
	Your Address
	City
	State
	Zip code
	Your Phone #
	*e-Mail Address

*your e-mail address is required to submit form

Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released to a public-records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing.