DEDHAM-WESTWOOD WATER DISTRICT

WATER EFFICIENT FRONT LOADING WASHER

REPLACEMENT PROGRAM

APPLICATION FOR REBATE ($100.00, one per household)

Name_____________________________________ Account No. _____________

Property Address______________________________________________________

Mailing Address (if different)__________________________________________________

Phone No.___________________________

I hereby certify that I am a customer of the Dedham-Westwood Water District (the District) and that I am the property owner of the above referenced residential property. I agree to install the washing machine that I purchase under this agreement at the property address above. This washer must replace a washer that is not a front end loading washer. The washer must be purchased on or after September 12, 2006 to be eligible under this offer. I have attached the invoice for the appliance purchased. Also, in order to be eligible for this program, I understand that my account must be current.

I agree to indemnify and hold harmless and defend the District and all of its commissioners, officers, agents, employees or authorized agents, employees or authorized representatives from any claims, suits, actions, losses or liability of every kind, nature and description, including but not limited to, the delivery, installation, product malfunction, plumbing malfunction, maintenance or use of appliances purchased through this program.

I agree to install the washer that I purchase under this agreement at the above property address within sixty days of the date of purchase. I will also allow the District to inspect the installation of the washer within six months of installation. If access for an inspection is denied, the District will charge the water bill account for the amount of the rebate granted.

________________________________________________ _______________

Signature of Property Owner Date