SMART IRRIGATION SYSTEM CONTROLLER REBATE
The smart irrigation system controller rebate is offered one-time per service location. Rebate is equal to 50% of the purchase
price (max. $300) when you purchase an eligible model. The maximum for nonresidential customer is five controllers.
1. Account Information
Water Account Name_________________________________________________________
Water Account Number__________________
Date Attended Water Wiser Workshop ________________________ Qualified applicants are required to attend a Water Wiser Workshop
2. Installation Data
Name ___________________________________________________________________________________________________________________
Address _________________________________________________________________________________________________________________
City _____________________________________
Building Type (select one):
Zip_____________________
___ Single Family
___ Duplex
Phone ___________________________________
___ Multi-family
___ Nonresidential
3. Contact Information
Contact Person ( owner, or  tenant)___________________________________________________
Day Phone ___________________________ Evening Phone _____________________________ Best time to call _______________________
Email _____________________ (if available)
4. Traditional controller being replaced
Manufacturer (Make)
Model #
4. “NEW” Smart Irrigation Controller Information
Manufacturer (Make)
___________________________
Model #
Quantity
$___________________
Purchase Price
____/____/____
Date Purchased
Attach copies of your sales receipt.
5. Rebate Check Information and Address
Make check payable to (name)_________________________________________________________________________________________
Address ___________________________________________________________________________________________________________
City _______________________________________________________ State ________________________ Zip______________________
Mail to:
Castle Rock Water, Smart Irrigation System Controller Rebate
175 Kellogg Court, Castle Rock, CO 80109
SMART IRRIGATION SYSTEM CONTROLLER REBATE
1. Information
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This rebate program is intended to replace or upgrade their old controllers with new, weather-based
technology.
Smart controllers must be installed in the Town of Castle Rock water service area, Castle Rock,
Colorado.
Attach a COPY of the original sales receipt to this application.
I agree to the terms of the Rebate Program as listed below and sign Affidavit of Lawful Presence
Send this acknowledgement and affidavit to “Smart Controller, 175 Kellogg Ct., Castle Rock, CO 80109”,
or email at [email protected]. Submission of the on-line application is not considered complete until the acknowledgement and affidavit are signed by the applicant. Once this information is
received, the rebate application will be processed in the order of receipt.
Funds are limited, and are available on a first-come first-served basis.
Rebate checks will be issued within three (3) to six (6) weeks completion of the on-line application,
acknowledgement and affidavit.
To be eligible for a rebate, you are required to bring in the traditional controller that was replaced as part of
the application. The old controller will be recycled by the Town of Castle Rock.
2. Rebate Program Terms
I understand:
 Participants are limited to one rebate per household.
 Rebates will be processed in the order they are received, and are limited by available funding.
 Program will reimburse me for 50% of the purchase price of the new smart irrigation controller (excluding
installation costs, taxes and shipping/handling) up to a maximum of $300; nonresidential customer maximum is five controllers.
 Actual water savings may vary, and will depend on weather and programming..
 The smart irrigation controller must be installed on a fully operational automatic irrigation system.
 Smart irrigation controller must be new and meet qualifying criteria.
3. Signature
Print Name____________________________________________________
Date_____________________
Signature of Applicant ________________________________________________________________________
Address ___________________________________________________________________________________
April 2017
AFFIDAVIT OF LAWFUL PRESENCE IN THE U.S.
(Required for Town of Castle Rock Rebate Applications)
I, ____________________________________ (print name legibly), swear or affirm under penalty of perjury under the
laws of the State of Colorado that (check one):
____ I am a United States citizen, or
____ I am not a United States citizen, but I am a Permanent Resident of the United States, or
____ I am not a United States citizen, but I am lawfully present in the United States pursuant to Federal law.
I understand that this sworn statement is required by law because I have applied for a public benefit. I understand that
state law requires me to provide proof that I am lawfully present in the United States prior to receipt of this public benefit. I further acknowledge that making a false, fictitious or fraudulent statement or representation in this sworn affidavit
is punishable under the criminal laws of Colorado as perjury in the second degree under Colorado Revised Statute 18-8503 and it shall constitute a separate criminal offense each time a public benefit is fraudulently received.
__________________________________________
Signature
_____________________
Date
Acceptable forms of identification:
 a valid Colorado driver’s license;
Note: The Colorado Department of Revenue will allow us to accepts a driver’s license from the District of Columbia
or any of the following 33 states: Alabama, Arizona, Arkansas, California, Connecticut, Delaware, Florida, Georgia,
Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Minnesota, Mississippi, Missouri, Montana, Nevada, New
Hampshire, New Jersey, New York, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina,
South Dakota, Virginia, West Virginia, or Wyoming;
 a valid Colorado identification card;
 a United States military card;
 a United States military dependent’s identification card;
 a United States Coast Guard Merchant Mariner card;
 a Native American tribal document;
 a birth certificate issued by a state, county or parish;
 a naturalization or citizenship certificate;
 a court-issued adoption order
 an unexpired foreign passport
 an I-94 immigration form with refugee or asylum status; or
 an unexpired resident alien card, permanent resident card, temporary resident card, or employment authorization
card.
In addition, you must sign an affidavit stating either: (1) you are a United States citizen; or (2) you are a legal permanent resident of
the United States; or (3) you are otherwise lawfully present in the United States pursuant to federal law. A blank affidavit is attached
for your convenience.
Please mail a photocopy of your identification (in one of the forms listed above) and your signed affidavit along with the other rebate
paperwork.
Under House Bill 06S-1023, anyone 18years of age or older must prove lawful presence in the United States to receive public benefits.
For information on acceptable forms of identification, visit the Colorado Department of Revenue at:
https://www.colorado.gov
Staple Copy of Applicable Identification Form Here
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