### 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 opt ions: - Using Windows, hold Ctrl key and select multiple options with mouse. - Using a Mac, hold Command key and select multiple options with mouse.

Yes No Retailer/Distributor Name on Partnership A g reement *  Please select...

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 Please select... Primar y Contact Reporting Technical

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 Please select... Primary Contact Reportin g Technical
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1a. Are y ou promotin g y our WaterSense labeled products to consumers or other stakeholders? *           1b. Please estimate the number of customers reached in 2012 (e. g ., throu g h circulars, via the Web, store visitors, etc.) * 1c. Please indicate how y ou are promotin g y our WaterSense labeled products. *
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 Please select... In-store promotions, such as displa y s and other si g na g e Ads and circulars Brochures, other marketing materials Other description 1d. If y es, are y ou workin g with other t y pes of partners (e. g ., utilities or manufacturers) to promote WaterSense labeled products to consumers? *

          Please elaborate on y our efforts and include the sp ecific partners with whom y ou're workin g . * Pa g e 1 of 3To 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.

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Please go to the awards page for application materials and instructions. Award app lication materials will be available on the WaterSense partner website by February 1. WaterSense encourages all retailer/distributor p artners who actively promot ed WaterSense labe led products in 2012 to apply regardless of company size.

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 for accessing a PDF form to submit your product sales data in accordance with our confidential business information procedures.  

  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 *  

  3. 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? *  

  4. On a scale of 1 to 5 (5 = most valuable), how valuable do y ou find the WaterSense partner website? *
 Please select... 5. In the past y ear, how often have y ou visited the WaterSense partner website? *  Please select... 6. B y submittin g both y our online and hard cop y annual reportin g forms, y ou will be eli g ible to appl y for a 2013 WaterSense Partner of the Year award. WaterSense encourages all partners to apply regardless of company size. Are you interested in applying for an award this year? *

          Help us improve the awards pro g ram b y tellin g us wh y y ou're not interested in appl y in g for an award. *
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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 3Please 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. Your Annual Reporting Form will not be complete unt il WaterSense receives both your online and hard copy reporting forms.
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