HERG Toilet Rebate Form

Please complete all sections of the form and submit it online to Vancouver Heritage Foundation.

The Heritage Energy Retrofit Grant supports a direct rebate of $100/toilet for up to two toilets, meaning the maximum rebate is $200 for the installation of two high efficiency toilets for an approved participant in the program. Each toilet must use a maximum of 4.8 litres per flush.

Applicants must already be participants in the Heritage Energy Retrofit Grant Program to qualify.

If you have additional questions about the program, you can refer to the Heritage Energy Retrofit Grant Program page on the VHF website for program guidelines, and updates.

Application #
Grant House Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
The replaced toilet(s) used minimum 13 litres per flush.*
Number of high efficiency toilets installed.*
1st Toilet, please indicate where you purchased the toilet from.*
2nd Toilet, please indicate where you purchased the toilet from.
1st Toilet, please provide the name of the manufacturer the toilet.*
2nd Toilet, please provide the name of the manufacturer the toilet.
1st Toilet, please provide the model # of the toilet.*
2nd Toilet, please provide the model # of the toilet.
1st Toilet, please provide the total cost for the toilet including taxes.*
2nd Toilet, please provide the total cost for the toilet including taxes.
Please list at least one additional retrofit that has been completed (at least 1 other retrofit required).*
Upload your receipt(s) for each toilet here.*
Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 24 MB.
Consent*
Receipt(s) included: By signing below I verify that the receipt(s) for the purchase of toilets reflect the new, qualifying high efficiency toilets that have been installed at the above address. I wish to receive the Toilet Grant and agree to comply with the Terms and Conditions of the Heritage Energy Retrofit Grant program. I am aware that during the post-retrofit evaluation my Energy Advisor may verify the new toilet(s) meet the high efficiency criteria, have been installed and are functioning. VHF reserves the right to visit to confirm new qualifying toilets have been installed. A maximum of two toilets may be claimed per household for a maximum grant of $100 per toilet. I will ensure the old toilet(s) are recycled and will not be reused. All information is true and correct.

I agree that the above information is accurate and correct.
Name*
First Last
Date*
MM slash DD slash YYYY

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