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Tree Rebate Request

2. ALL PROGRAM REGULATIONS OUTLINED ON THE TREE REBATE PROGRAM FORM APPLY
   Rebate Regulations

4. Instructions:
   Complete this form and attach a copy of your receipt that shows the cost of each tree and the tree tag (for new plantings) that clearly identifies each tree by the common name or scientific name.

   Complete this form and attach a copy of your receipt that shows the cost of each tree and the tree tag (for new plantings) that clearly identifies each tree by the common name or scientific name.

6. Approved Quantity

7. Denied Quantity

8. Rebate Amount

10. Representative

11. Budget Code

15. Name*

16. Property Address*

18. City*

19. State*

20. Zip Code*

22. Phone Number*

23. Email Address*

25. Different Mailing Address?*

    1. Yes
    2. No

26. Address

28. City

29. State

30. Zip Code

34. Planting or Removal*

    1. Planting
    2. Removal

35. Quantity*

36. Type of Tree(s)*

38. Location in Yard*

40. Vendor or Contractor*

41. Cost (including tax)*

45. Attach Receipt*

46. Attach Tree Tag (New Plantings Only)

48. Additional Information

Leave This Blank:


52. 1. Receive an email copy of this form.
53. Email address

    This field is not part of the form submission.

54. Submit Submit and Print

* indicates a required field