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Residential High Efficiency Toilet - Rebate Program Application (July 1, 2021 to June 30, 2022)

  1. Title II Compliance
    In accordance with the requirements of Title II of the Americans with Disabilities Act (“ADA”) of 1990, the Fair Employment & Housing Act (“FEHA”), the Rehabilitation Act of 1973 (as amended), Government Code section 11135 and other applicable codes, the City of Modesto (“City”) will not discriminate against individuals on the basis of disability in the City’s services, programs, or activities. For more information, please visit the City of Modesto website.
  2. Providing an Email address will speed up the response time to your application.

  3. If your mailing address differs from your physical address please provide it here.
  4. Are you the Property Owner?*
  5. Have you previously applied for this rebate?*
  6. Attach to application
  7. Rebate Information
    • The rebate value cannot exceed the actual cost of the toilet(s).
    • An original itemized dated sales receipt is required to qualify for the rebate.
    • Application must be received within 60 days of sales receipt.
    • Approval based on County record of the number of bathrooms on the property.
    • Compliance with attached guideline is required.
    • Home must be built before 1992.
  8. Terms and Conditions
    The City of Modesto may deny any application that does not meet program requirements. The undersigned expressly agrees that the City may inspect all items submitted for the High Efficiency Toilet Rebate Program. The City does not guarantee the performance of any toilet; does not warrant any toilet or installation to be free of defects, the quality of the workmanship, or the suitability of the premises or the toilet for installation. The undersigned further agrees to hold harmless the City of Modesto against all loss, damage, expense and liability resulting from the loss, destruction or damage to property arising out of or in any way connected with installation of the toilet. The City reserves the right to alter this program at any time. Funding for this rebate program is limited to available resources. Rebates are processed on a first come, first served basis.
  9. Electronic Signature*
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