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<br /> Baekwater Fre�ention Device Rebaxe.Pr"ogram .`_ `:
<br /> Rebate;Application•Form . �
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<br /> Prop�rty Ocmer Nzme ��✓GiJ_=/� ��✓SCt.tl1�.�— --- �
<br /> � � . � �Jn,tallotion Address� _� �/-/•`'�.''�� DIn:Ut}?�' � _Sl�-- _ _ � I
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<br /> � � � � � I�4alling Address (i;Uiflerenrl .:=�f�t� \N.�L�l�OI� �
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<br /> � � Total�Cosfto Inslall D'e�ice(4am cu�t�a..to� nvoiceJ s _ _ - � �
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<br /> � "!ec�so.venfy the following ''" _ i
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<br /> � � . � I am lhe o�.ner o(the:property�'her� ihe ba Kuater prc:cntion devicr, +�5 nst�lled ^ _ �
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<br /> ' - � � ❑ I t:�orked vnth lho c�n� ac ., o deterr ii�e-t5e�ioc�tion`cethP back �atPr prevenGon de�icc ond - �
<br /> uniiersland thal ihe�dF ,sion�rzgaiomg-the.lecau�n of�ihE� 'evi ..e;as m ne - - -. �
<br /> � � �.❑ h�'ry conuaclor ,nstr�cted r^e h 1v�:to a �ss�:�tm��c 3nd���mafr� 3 n Il��r de�icr � �
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<br /> �. -❑ I:understand tha�l,am responsi6le`e,r maintairnng �heba,c � dter �revcnhen deVice and keepir y _ �
<br /> � � . it in�good��•+orkingprder iinless it�is mstalled�in th'e ciFy.righC of ,:aj� . i
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<br /> � '. i�] I(bsell m} p�operly'I�-��ill mate pot�nti�l buyers A� ar� oCthe b i�k�,vaiu pri�entio� e and �
<br /> . , �. the need lo inspect;a�d maintainit oma iegular h�sis - ; ; ��--_ - i
<br /> _ �;�0 �I am.enclosinq �Il�pf:t! e neccssar.� piNen�o;k�u e the_yell��� R�batc Suhmi tai�Chacrlisl)::' � . �
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<br /> � ����Setect from lhe followinq . '
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<br /> ``�[] The conir�clor idenlific,l do�+nsp�uK or o�her dramayP�.11ints th�l �ere�on�Pcicd lo mv�A;+er � � ��, �
<br /> -� ��line (tiet�veen niy�hous� �iiid lfie'ihs�411ed�'devic,� �rcl,remuv�d•�cY�ei�u�ed�the�ii� "'" �
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<br /> � �_ ;�� To rny�knov:ledqe, tny prooriiy hes no do�vris��ou(s cd�o0ier d �in3�jr c�m�eten lo m� s�v�et Ilne
<br /> � . - . � (beh•reen.my house and ihe Inslall�d device). ( . i
<br /> �,�[] Tnere are dor.nspou,� ,ur o li.r�d,iinuy��lir,cs ronnec��'d=ti,m} �,cwei line!t eh•�ern rny ho�iSe . i
<br /> � and�lhe-inslailed-Ue'vicAl '�undFrstand th:it:leavi�q thescconneclions rrF�tes a�iisk ot inoding '
<br /> .:- and I acceptthal risk� � . - �
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