General Information 

Contact Name(s)

Please provide U.S. contacts if possible. This information is for internal use only, WaterSense will not share contact 

information. 

Name * 

Email * 

Telephone * 

Contact Type * To select multiple options: - Using Windows, hold Ctrl key and select 

multiple options with mouse. - Using a Mac, hold Command key and select multiple options 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 Availability and Program Feedback 

Information on WaterSense's impact on the marketplace is vital to the continued success of the program. Please 

provide data on product availability and promotion. 

Yes

No 

 Please enter a number without commas. 

 To select multiple options: - 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 Agreement * Please select... 





Please select...

Primary Contact

Reporting

Technical

Please select... 





Please select...

Primary Contact

Reporting

Technical

Please select... 

1a. Are you promoting your WaterSense labeled products to consumers or other stakeholders? * 



1b. Please estimate the number of customers reached in 2012 (e.g., through circulars, via the Web, store 

visitors, etc.) *

1c. Please indicate how you are promoting your WaterSense labeled products. *





Please select...

In-store promotions, such as displays and other signage

Ads and circulars

Brochures, other marketing materials

Other description

1d. If yes, are you working with other types of partners (e.g., utilities or manufacturers) to promote 

WaterSense labeled products to consumers? *

 

Please elaborate on your efforts and include the specific partners with whom you're working. *

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Retailer and Distributor - Annual Reporting
 To select multiple options: - 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 

 

Please go to the awards page for application materials and instructions. Award application materials will be 

available on the WaterSense partner website by February 1. WaterSense encourages all retailer/distributor 

partners who actively promoted WaterSense labeled 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 portion 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 your company participate in any WaterSense promotional campaigns last year? *





Please select...

Fix a Leak Week 2012

We're for Water

Peak water season outreach

Other description *

Please elaborate on your company's participation * 



3. On a scale of 1 to 5 (5 = most valuable), how valuable do you find the WaterSense program? *

Please select... 

How has the WaterSense label added value? * 



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

Please select... 

5. In the past year, how often have you visited the WaterSense partner website? * Please select... 

6. By submitting both your online and hard copy annual reporting forms, you will be eligible to apply 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 program by telling us why you're not interested in applying for an award. *





7. Please provide suggestions for improving the WaterSense program (e.g., general tools/materials, 

webinar topics, communications, Helpline, websites, etc.) *





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Please note that you may need to try different 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 until WaterSense receives both your online and hard 

copy reporting forms.

Need assistance with this form? 

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