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2. First Name*
3. Last Name*
5. Address*
6. City*
8. ZIP*
9. Email Address*
11. Phone
13. Please check the boxes below for the items you would like to receive:*

    1. Toilet Dye Tablet
    2. Toilet Flapper
    3. "FlushLess" Water Displacement Bag
    4. Hose Nozzle
    5. Faucet Aerator
    6. All of the above

15. Thank you for requesting your free water savvy kit. Please allow up to 3 weeks to receive your items. 

    *Must be a CVWD customer*

    While supplies last. 

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17. 1. Receive an email copy of this form.
18. Email address

    This field is not part of the form submission.

19. Submit

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