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2. 
3. WaterSense Product Rebate Form

   Qualified, WaterSense labeled products must be purchased between 01/01/22 and 12/31/22. Customers of the Ipswich Water Department, in good standing are eligible to receive one rebate of each product listed every three years. Rebates will be applied as a credit to the water account number provided. The Ipswich Water Department reserves the right to limit or end these rebates at any time.

5. Verify your Purchase
   epa.gov/watersense

   Click the link above to verify the product you purchased qualifies.
9. Water Account Number:*
   Please enter your Ipswich Water account number
10. Email Address*
11. Phone Number*
13. First Name
14. Last Name*
16. Service Address*
17. Mailing Address
    (if different from service address)
19. City
20. State
21. Zip
25. WaterSense Product*
    -- Select One --Low Flow Toilet - $100Showerhead - 25% up to $50Bathroom Faucet - 25% up to $50Irrigation Controller - 25% up to $100Spray Sprinkler Bodies - 25%Pre-Rinse Spray Valves - 25% up to $50Washing Machine - $50Kitchen Faucet - 25% up to $50

    Select the purchased Product
26. Purchase Date*
    Purchase Date
    Please provide the date of purchase.
28. Receipt*
    Please upload your dated sales receipt. (must show qualifying model, purchase price and paid in full.)
29. Brand*
30. Model #*
31. Serial #*
35. Customer Acknowledgement
    By submitting this form, I hereby certify that all information above is correct to the best of my knowledge and that I adhere to all terms and conditions of this rebate.
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37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field