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<br /> Backwater Prevention Device
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<br /> �F � Rebate Prograrn
<br /> Vendor Section (plcasc print):
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<br /> Vendor N�me l pusiness Nan�c / U61 Nund�cr
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<br /> S�a�e o(Waslungfun ConL ar�or l icen r Numbm
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<br /> I Vendoi (daihng Ad�l��:s; Cdy Slate Zip
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<br /> Phone 1 n��il
<br /> I, the Vendor, agree to rer,eive the f3ackwater Preoe� tion Device rebata� check dnectly
<br /> for the installation referenced at ihe Property Address !iy agiee�ng to receive the retrd�;
<br /> check directly, I agree to the (ollowin�.
<br /> 1 I he f3ackwater F'rr.vention f)ewr,r, rehatn amount �vlll be deducted (rom the hn�,l
<br /> invoice given lo the Nroperty Owncr (x thc installaLon at thc Pruperty Arldre; ,
<br /> referenced above, i( the �otal cosl nf tlie inst;�llation is qreri�er than Ihe reb�itc
<br /> 2 I, the Vendui, ,�m a Washlnylqn ;;la�e hr.ensed conir�clor
<br /> 3 Thr. City of f�v�rrr.11 will scnd �� Pr,deral Funn 1099 �✓11SC lu ine, Ih�� Vendor, (��r
<br /> Ihe 8ackwater Nrevenhon I)nvic�-; reb.��cr payrnent�, to�,il;ny rnor�• Ihan $600 �,��r
<br /> calendar yr,,ir, and will re��nrt Ihu ;;c�me payin�•nt; lu �hu Intcin,ii I:evenue
<br /> Servic��
<br /> I accr:pl thu duec� prryrnenl u( the L',��.h�v,�tiv f'ir�virntiun (�evn:�r n�bnle hurn the Cily
<br /> ul Lvci���l pi�nihn�� ��p(�roVal r�( Ihc �.��tn�drt�vl R�u kn-�i;ci �rr�vi�ntu�n I)cw;.�� i��b,+lu
<br /> �,�ckage by the City o( Ever�•it
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