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2. Please note: All information must be provided.
4. First Name:*
5. Last Name:*
6. Preferred Name:
8. Address1:*
10. City:*
11. State:*
12. Zip Code:*
14. Phone Number: *
    Example: (xxx) xxx-xxxx
15. Alternate Phone Number:
    Example: (xxx) xxx-xxxx
16. Email Address:*
    
    
18. Would you like to receive text messages from the contractor for scheduling?

    1. Yes (Opt-In)

    *Cell phone number must be provided as primary phone number.
20. Pre-qualification Questions:
22. Account Number:
    *
    *Your account number can be found on your water bill or by calling (909) 364-2660.
23. Approximate Parcel Square Footage (10,890 sq ft or more):*
    *Must be greater than 10,900 square feet
    
25. I understand that this is only an irrigation controller and nozzle program.*

    1. Yes
    2. No
26. Do you have an existing indoor or outdoor automated irrigation controller?*

    1. Yes
    2. No
27. Can your current sprinkler timer (or timers) be operated by any smart device (phone, computer or tablet)?*

    1. Yes
    2. No
29. Is the irrigation controller connected to the irrigation valves?*

    1. Yes
    2. No
30. Is your irrigation system working now?
    *

    1. Yes
    2. No
32. Property Owner Age Range:
    *

    1. 21-31
    2. 32-42
    3. 43-53
    4. 54-64
    5. 65+
33. How did you hear about this program?*

    1. City Brochure/Recreation Guide
    2. City Letter
    3. Family/Friend/Neighbor
    4. Social Media
    5. Other
34. Are you the homeowner or tenant?*

    1. Homeowner
    2. Tenant

    *Tenants may apply, but only with the permission of the property owner. Contact information for both parties MUST BE listed on the application.
36. Additional Comments:
    *Please provide any information that we should know about the property.
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit Submit and Print

* indicates a required field