Quick example demonstrating display of form data.
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City of Castlegar Toilet Rebate Program
| Contact Details | |
|---|---|
| First | Mozelle |
| Last | Hermon |
| Address | 523 Spencerville Ct Castlegar, BC ABC 255 Map It |
| Email hidden; Javascript is required. | |
| Phone (home/cell) | (604) 123-4699 |
| Toilet Information | |
| Toilet installed by | self |
| Toilet manufacturer / brand | American Standard |
| Toilet name / model | ABC |
| Flow rating (6 litre or HET) | 10GPM |
| Approval system | Warnock Hersey |
| Purchase date | 09/06/2021 |
| Purchase price with PST | $ 100.00 CAD |
| Would you have replaced your old toilet without a rebate? | Yes |
| Registered Property Owner Declaration |
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