Exit this survey

1.

Please take a few minutes to complete this short survey as part of the rebate program application. This survey is the last step in the application process; once finished and approved the Town of Firestone will issue your rebate. Please allow 6 to 8 week for the rebate program process.

Question Title

* 1. Applicants Information:

Question Title

* 2. Water Account Number:

Question Title

* 3. What type of rebate have you applied for?

Question Title

* 4. Why did you decided to install a new High-Efficiency Toilet?

Question Title

* 5. Please answer yes or no pertaining only to the type of rebate you have applied for:

  Yes No
Compared to your old toilet, does your new toilet require double flushing?

Question Title

* 6. Please answer yes or no pertaining only to the type of rebate you have applied for:

  Very Satisfied Somewhat Satisfied Neither Satisfied nor Dissatisfied Somewhat Dissatisfied Very Dissatisfied
How satisfied are you with the amount of rebate for the High-Efficiency Toilets?

Question Title

* 7. Comments about the rebate program:

T