### Section 1: General Information
Please fill out an d submit this form electr onically to WaterSense by Monday, April 1, 2013 . If you have any questions, please refer to the Frequently Asked Questions page or email the WaterSense Helpline. To save a draft of this applic ation, select “Save my progre ss and resume later”. You will be prompted to provide an email address and password that you w ill use to re-enter the form. WaterSense does not have access to these passwords, so please keep your password in a safe place. Please fill in the following information as it relate s to your organization:

Please enter a numbe r without commas. Please enter a number without commas. Please enter a number without commas.



### Section 2: Eligibility Yes, our organization became a Water Sense partner prior to January 1, 2013. Yes, our organization submit ted a 2012 annual reporting form. 

### Section 3: Organization Description

Section 4: Written Statement If you haven’t done so already, please download, complete, and save your written statement

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Acceptable file formats: Word or PDF. Or g anization Name  Please select... Number of Stores or Sh owrooms (if Applicable) Number of Customers, Annuall y (Approximatel y ) * Number of Emplo y ees in the U.S. (Approximatel y ) * If y our compan y has brick and mortar stores, please provide the percenta g e of stores that offered WaterSense labeled products in 2012:
B y what percenta g e did y our total WaterSense labeled stock assort ment (online and in stores) increase from 2011 to 2012?

Phone * Format (xxx xxx xxxx) Fax Email * Contact Name (for awards-r elated communications) * Title

Please verif y y our eli g ibilit y : *          

Briefl y describe y our or g anization in no more than 300 words. If selected to receive an award, this description may be used in recognition materials. *

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Please upload y our final written statement, in which y ou have addressed the evaluation criteria. * Browse... Pa g e 1 of 2

### Section 5: Supporting Materials Please note: WaterSense is no longer accepting hard copy sup porting materials. Partners are also asked to limit their electronic supporting materials to 25 pages. Additional supporting materials will not be reviewed.

Upload more supporting materials
Please note: Individual files may not exceed 5 MB. To tal file size may not exceed 20 MB. We understand that some high-resolution photos may be quite la rge and push your application over the 20 MB file size limit. Therefore, you may send up to 10 additional ph otos of your 2012 WaterSense-related activities to watersenseawards@erg.com . These photos may be used in recognition materials if your organization is selected for an award. Materials other than photos sent to this ema il address will not be reviewed with your application. Your application form, including the written statement and supporting materials, must be submitted by Monday, April 1, 2013 to be considered for an award. 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 your award application to WaterSense. Please note, you may need to tr y different printer settings or print as a PDF to print the full report for your records. We apologize for any inconvenience.

N eed assistance with this form? Please upload an y supportin g materials that help demonstrate the accomplishments described in y our written statement. Includin g supportin g materials is not required, but is stron g l y encoura g ed. To upload additional supporting materials, pl ease use the "Upload more supporti ng materials" link below the first record. Browse... Pa g e 2 of 2