Gravity Forms Demo

Quick example demonstrating collection of form data.

Drag-and-Drop Builder
Field Validation
Calculations
Quizzes and Polls
Surveys
File Uploads
Import & Export
Email Logic – based on user selections and conditional logic
Ecommerce – discount codes / coupons
Payment Processor Integration
Generate Charts

Note to City of Castlegar Staff

Feel free to submit the form as yourself. Your entry will show immediately on https://castlegar.icontext.ws/views/.

City of Castlegar Toilet Rebate Program

The City of Castlegar’s Toilet Rebate Program provides a utility tax rebate to single and multi-family homeowners who replace an existing 13-litre toilet or greater with a low-flush toilet (6-litre or less).

Applications for the City of Castlegar Toilet Rebate Program must be received by December 31, 2021.

For more information on the City of Castlegar’s Toilet Rebate Program, visit our website at castlegar.ca or contact (250) 365-5979.

Contact Details
Name*
First Last
Address*
Street Address Address Line 2 City Province Postal Code
Phone (home/cell)*
Email*
Toilet Information
Toilet installed by*
- plumber
- self
Conditional Field - If Plumber*
Toilet manufacturer / brand*
Toilet name / model*
Flow rating (6 litre or HET)
Approval system
- CSA
- Warnock Hersey
Conditional Field - If Self*
Store purchased from*
Purchase date*
MM slash DD slash YYYY
Purchase price with PST*
Would you have replaced your old toilet without a rebate?*
- Yes
- No
Application package should include:
- Original sales receipt indicating how many litres per flush toilet uses
- Photograph of old toilet in place
- Photograph of new toilet in place
**Resident submitting the rebate application should be in both photographs. **Photos and original receipts will not be returned.
File*
Drop files here or

Max. file size: 4 MB, Max. files: 3.
Declaration
Registered Property Owner Declaration*
- Yes, I am the registered property owner in the City of Castlegar
I declare I am the registered property owner in the City of Castlegar. I have installed a CSA or Warnock Hersey approved 6-litre, HET or dual-flush toilet in my home. The City of Castlegar reserves the right to inspect or verify that toilets have been installed. Rebates shall be repaid to the City of Castlegar should the toilet be returned for cash / credit refund or exchanged for an ineligible toilet. I have read and understood the terms of the program and understand the City of Castlegar is not responsible for the installation or function of the toilet. This rebate offer may be withdrawn without notice.

Gravity Forms Demo

City of Castlegar Toilet Rebate Program

Contact Details

Toilet Information

Declaration