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Toilet Replacement Rebate Application Form

  1. Found on the top-right corner of your utility bill.

  2. If you are not the property owner, please provide the owner’s name and contact information
  3. Are you applying for one or two toilet rebates?*

    max. 2 per dwelling

  4. max. 4.8L or 1.28 gallons for single; 4.1/6L or 1.1/1.6 gallons for dual

  5. Canadian Certification Type

    Found on the inside or outside of the water tank.

  6. Supporting Documents Checklist

    Email to Water Conservation and include your address for reference.

  7. Did this rebate program encourage you to replace your toilet?*
  8. Freedom of Information and Protection of Privacy*

     By submitting this form, you are consenting to the collection, storage, use and disclosure of your personal information. The City has authority to collect, use and disclose your information for the purposes of the City’s Toilet Rebate Program in accordance with Section 26(d) of the Freedom of Information and Protection of Privacy Act. Your personal information will be disclosed to a third-party service provider (i.e. website host Civic Plus) located in Canada for the purpose of processing your request.  Should you have any questions or concerns about the collection of your personal information please contact Britta Ng, Water Conservation Coordinator, by email.

  9. Leave This Blank:

  10. This field is not part of the form submission.