Water Conservation Kit Order Form

1. ACWD provides one complimentary water conservation kit per eligible customer account.
   Please Note: Newer and remodeled homes may not qualify. Each kit contains one low flow showerhead, faucet aerators for the bath and kitchen, toilet leak detection tablets, and a toilet flapper valve, all packed into a flow meter bag.

   Please Note: Newer and remodeled homes may not qualify. Each kit contains one low flow showerhead, faucet aerators for the bath and kitchen, toilet leak detection tablets, and a toilet flapper valve, all packed into a flow meter bag.

2. Please provide complete contact information.
   You can also pick up your kit at the ACWD headquarters at 43885 S. Grimmer Blvd. in Fremont. Please call ACWD's Water Conservation Department at (510) 668-6534 or email Stephanie.penn@acwd.com if you have questions.

   You can also pick up your kit at the ACWD headquarters at 43885 S. Grimmer Blvd. in Fremont. Please call ACWD's Water Conservation Department at (510) 668-6534 or email Stephanie.penn@acwd.com if you have questions.

3. ACWD Water Account Number (if known)

4. Phone*

5. Reply Email Address*

   Enter the email address you would like us to reply to.

6. First Name*

7. Last Name*

8. Street Number*

9. Street Name*

10. Street Type

11. Apt #

12. City*
    1. Fremont
    2. Newark
    3. Union City

    You must be a resident of one of these communities to receive a water conservation kit.

13. Zip*

14. Mailing Address (if different from service address above)

15. I live in a Homeowners Association*
    1. yes

    1. no

16. Homeowner Association's Name

    If you live in a Homeowners Association Community, please provide the name of the HOA above.

18. Age of Home*
    -- Select One --Built prior to 1980Built between 1980-1994Built after 1994

    Please provide information about the age of your home.

19. 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 remodled within the last 18 years
Leave This Blank:


20. 1. Receive email copy
21. Email address

22. Submit

* indicates a required field