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2. ACWD provides a complimentary water conservation kit per eligible customer account.

   Please Note: Each kit contains one low flow showerhead, faucet aerators for the bath and kitchen, toilet leak detection tablets, and a home water audit booklet.

4. Please provide complete contact information.

   Kits will be delivered within 10 business days. Please call ACWD's Water Conservation Team at (510) 668-4218, if you have questions.

6. ACWD Water Account Number (if known)
7. Phone*
9. Reply Email Address
   Enter the email address you would like us to reply to.
11. First Name*
12. Last Name*
14. Mailing Address:
16. Street Number*
17. Street Name*
18. Street Type
19. Apt #
21. City*

    1. Fremont
    2. Newark
    3. Union City

    You must be a resident of one of these communities to receive a water conservation kit.
22. Zip*
24. I live in a Homeowners Association

    1. yes

    1. no
25. Homeowner Association's Name
    If you live in a Homeowners Association Community, please provide the name of the HOA above.
29. Number of Bathrooms in Home*
    -- Select One --1234+
30. Age of Home
    -- Select One --Built prior to 1980Built between 1980-1994Built after 1994

    Please provide information about the age of your home.

32. Information about fixtures in your home

    Check all that apply.

    1. Our bathroom has NOT been remodeled within the last 18 years
    2. Our toilets have NOT been replaced within the last 18 years
    3. Our kitchen has NOT been remodeled within the last 18 years
33. How did you hear about this offering?
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field