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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:*
14. Phone Number:*
    Example: (xxx) xxx-xxxx
15. Alternate Phone Number:
    Example: (xxx) xxx-xxxx
16. 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.
18. Email Address:*
19. Account Number:*
    *Your account number can be found on your water bill or by calling (909) 364-2660.
20. Approximate Lot Square Footage:*
    *Must be less than 10,900 square feet
22. Pre-qualification Questions:
24. Do you have an existing indoor or outdoor automated sprinkler timer?*

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

    1. Yes
    2. No
26. Is the sprinkler timer connected to the irrigation valves?*

    1. Yes
    2. No
28. Is the irrigation system working now?*

    1. Yes
    2. No
29. Do you have more than 500 square feet of living landscape (grass, trees and shrubs)? Artificial turf is NOT included.*

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

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

    1. City Brochure/Recreation Guide
    2. City Letter
    3. Family/Friend/Neighbor
    4. Social Media
    5. Other
33. 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.
35. Additional Comments:
    *Please provide any information that we should know about the property.
Leave This Blank:


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

    This field is not part of the form submission.

39. Submit Submit and Print

* indicates a required field