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2. Lawn Replacement Application – Finished Project Submittal Form
4. First Name*
5. Last Name*
7. Project Address*
9. City
10. State
11. Zip
13. Email*
14. Phone Number*
15. Account Number*
17. Project Design*
18. Final Project Area*

    (REMINDER: Must be a minimum of 200 square feet to qualify for rebate.)

19. Final Project Cost*
21. Upload Final Project Design*
22. Upload Receipts/Invoices*
24. Signature*

    1. I AGREE

25. I have read and understand the conditions of eligibility for this rebate as stated in the program rules available on the Lawn Replacement Program webpage and understand that this rebate is conditioned upon my compliance with these terms. I understand that all documents, including receipts, become the property of the Town of Frederick once submitted, and the Town of Frederick reserves the right to randomly inspect my premise to verify the installation landscaping is in alignment with submitted design prior to issuing my rebate. I understand that the installation of a qualifying landscaping does not guarantee a reduction in my water bill. This rebate is subject to the availability of funds and may be changed or discontinued without notice. I further acknowledge that making a false, fictitious, or fraudulent statement or representation is punishable under the criminal laws of Colorado as perjury in the second degree under Colorado Revised Statutes § 18-8-503 and it shall constitute a separate criminal offense each time a public benefit is fraudulently received, pursuant to Colorado Revised Statutes § 26-1-127.

27. Signature*
28. Date*
    Date
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30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field