### General Information
Contact Name(s) Please provide U.S. cont acts if possible. This information is for inte rnal use only; WaterSens e will not sh are contact information. Name * Email * Telephone * Contact Type * To select multiple options: - Usi ng Windows, hold Ctrl key and select
multiple options with mouse. - Using a Mac, hold Command key and se lect multiple optio ns with mouse. Contact Update? * Name Email Telephone Contact Type
Contact Update? Please update your interests and preferences to receive more specific communications from WaterSense. 

### WaterSense Labeled Product Avai lability and Program Feedback Information on WaterSense's impact on the marketplace is vital to the cont inued success of the program. Please p rovide data on product availability and promotion. Yes No Please enter a number without commas. To select multiple options: - Usi ng Windows, hold Ctrl key and select
multiple options with mouse. - Using a Mac, hold Command key and se lect multiple options with mouse. To select multiple options: - Using Windows, hold Ctrl key and select multiple options

with mouse. - Usin g a Mac, hold Command ke y and select multiple options with mouse. Manufacturer Name on Partnership A g reement *  Please select...

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 Please select... Primar y Contact Reporting Technical

 Please select...

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 Please select... Primary Contact Reportin g Technical

 Please select...

1a. Are y ou promotin g y our WaterSense labeled products to consumers or other stakeholders? *           1b. Please estimate the number of consumers reached in 2012 (e. g ., throu g h circulars, via the Web, etc.) * 1c. Please indicate how y ou are promotin g y our WaterSense labeled products. *

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 Please select... On product packaging On the product itsel f Brochures and other marketing materials Other description * 1d. Do y ou mention WaterSense or include the WaterSense promotional label or partner lo g o on y our: Please select... Print advertising Broadcast advertisin g Web advertising Pa g e 1 of 3Yes No
To select multiple options: - Usi ng Windows, hold Ctrl key and select
multiple options with mouse. - Using a Mac, hold Command key and se lect multiple options with mouse.

3. Where can consumers find you r WaterSense labeled products?

On the following page, you will be asked to review your responses. You must select "confirm" at the bottom of the following page to submit the online port ion of your Annual Reporting Form to WaterSense. You will then be automatically directed to instructions fo r accessing an interactive PDF form to submit your product shipment data in accordance with our conf idential business info rmation procedures.
Please note that you may need to try diff erent printer settings or print as a PDF to print the full online report for your records. We apologize for any inconvenience. 1e. Are y ou workin g with retailers and/or distributors to promote y our WaterSense labeled products? *

          Which retailers/distributors are y ou workin g with? 2. Did y our compan y participate in an y WaterSense promotional campai g ns last y ear? *

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 Please select... Fix a Leak Week 2012 We're for Water Peak water season outreach Other description * Please elaborate on y our compan y 's participation *  

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Markets (e. g ., cit y , state, or re g ion) * Retailer/distributor compan y names * 4. On a scale of 1 to 5 (5 = most valuable), how valuable do y ou find the WaterSense pro g ram? *

 Please select... How has the WaterSense label added value? *  

  5. On a scale of 1 to 5 (5 = most valuable), how valuable do y ou find the WaterSense partner website?* *

 Please select... 6. In the past y ear, how often have y ou visited the WaterSense partner website?*  Please select... 7. Please provide su gg estions for improvin g the WaterSense pro g ram (e. g ., g eneral tools/materials, webinar topics, communications, Helpline, websites etc.) *

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  Pa g e 2 of 3Your Annual Reportin g Form will not be complete until WaterSense receives both y our online and hard copy reporting forms.

N eed assistance with this form? Pa g e 3 of 3

2/13/2013 file://C:\Documents and Settin g s\aauerbach\Deskto p \Forms\to do\wbic-manu-AR.html