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Showerhead Exchange Program

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					       Showerhead Exchange Program
                          Maribyrnong City Council Showerhead Exchange
                                  Corner Napier and Hyde Street
                                  Saturday 17th March 11am -2pm

                                Welcome to the showerhead exchange!

Please fill in the following information to swap your old showerhead with a new water-efficient one.

Full name: _____________________________________________________________________________
City West Water account number:___________________________________________________________
Telephone number: ______________________________________________________________________


Where did you find out about the shower head exchange program?
  Friend/family       Council           Local press           Internet          Other____________________


Please provide the following water consumption and greenhouse gas related information:


How many people permanently live in your home_______________________________________________
Number of showers in your home____________________________________________________________

Number of shower heads exchanged today____________________________________________________

What type of water heater does your house use:
   Gas                  Solar – gas boosted                   Don’t know
   Electric             Solar – electric boosted              Other

Before exchanging your showerhead please read the following information:

   •   If you choose to participate in the program, you will not be able to get back your original showerhead if you are
       unhappy with the new showerhead.
   •   You are responsible for installing your own showerhead. To assist you, we have provided instructions with your
       new showerhead.
   •   We are committed to being a greenhouse gas neutral business. This means that as well as saving water, this
       showerhead exchange will save energy and reduce the impact of greenhouse gases on the environment. We
       will use an independent verified method to estimate the amount of greenhouse gases saved from this program
       and will use this to offset our greenhouse gas emissions.
   •   We monitor the changes in water consumption of participating households. No individual household water-
       consumption is made public however overall savings from the program are sometimes reported.
   •   This program is not recommended for customers with gravity fed hot water services.



I have read and understood the above information.


Signature ___________________________________________________________________________

				
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Description: Showerhead Exchange Program