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Free Toilet Pre-Qualification Form

  1. Free Toilet Pre-Qualification Form

    This form is for customers with single family residential properties only. If you have a commercial or multi-family property, please call 707-543-3985, or email [email protected].

    Santa Rosa Water customers may be eligible to receive up to two high-efficiency toilets, showerheads and faucet aerators for kitchen and bathroom installed by qualified plumbers -- at no cost. Funding for this project has been provided in full or in part from the California State Budget Act of 2022 and through an agreement with the State Department of Water Resources. To see more program details, visit

    Eligible customers must:

    1. Be a Santa Rosa Water or sewer customer (pay your water or sewer bill to the City of Santa Rosa)
    2. Have a toilet(s) that flushes at 1.6 gallons per flush or more

    To be pre-qualified for the program, please fill out the information below.

  2. Information about the first toilet you’d like replaced:
  3. Information about the second toilet you’d like replaced, if applicable:
  4. By submitting this form, I am certifying that:*
  5. Thank you for completing the Free Toilet Pre-Qualification Form. Due to the high volume of submissions, it may take up to 4 weeks for the Water Use Efficiency Team to complete the pre-qualification process.
  6. Leave This Blank:

  7. This field is not part of the form submission.