Aquarion Water Company Toilet / Showerhead / Faucet Aerator Replacement Program Application
For Our Hingham, Hull, North Cohasset, Millbury, and Oxford Customers

Program Guidelines

  • Applicant must currently own and have an Aquarion Water Company account in good standing for the Massachusetts property where the installation of the replacement fixtures will occur.
     
  • Applicant’s residence includes toilets that are 1.6 gallons per flush (GPF) or greater.
     
  • Applicant must agree to replace all toilets that are 1.6 GPF or greater.
     
  • Aquarion Water Company’s Massachusetts Toilet / Showerhead / Faucet Aerator Replacement Program is on a first come, first serve basis.
     
  • After completing this form, a licensed plumber, working with Aquarion, will contact you to schedule a site visit to inspect the bathroom(s) to be upgraded and to confirm your fixture selection(s). This program covers the cost of the fixtures and standard installation. Additional plumbing repairs/replacements or other necessary work will be at the homeowner’s expense, based on the plumbers observations. Prior to beginning the installation, Aquarion's licensed plumber will provide the homeowner with an estimate for any additional expenses not covered by this program. The homeowner has the right to cancel the installation upon review of the estimate of additional expenses. The licensed plumber will not be responsible for putting back or re-installing any old fixtures if the homeowner elects not to complete any unforseen extra work necessary for the installation of the new fixtures.
     
  • Aquarion retains the option to cancel this program at any time and/or refuse to do some or part of any requested work based on the best interests of Aquarion Water Company.
     
  Participant Information:
    *Account Number:
 
    *Account First / Last Name
    
 
    *Installation Address
     
    *City
    *State
    *Zip
 -   
    *Daytime Phone Number
 -   -   Ext.   
     Evening Phone Number
 -   -   
    *Email Address:
(We will never disclose your email address)
 
*Age of Existing Toilet(s) or GPF
(This is sometimes on the inside
surface of the toilet tank or lid).

How many toilets will you be
replacing?
   *1. Toilet Age / GPF 
Age:   GPF:  
   *2. Toilet Age / GPF 
Age:   GPF:  
   *3. Toilet Age / GPF 
Age:   GPF:  
   *4. Toilet Age / GPF 
Age:   GPF:  
 
  Replacement Toilet # 1
   *Select Replacement Toilet 
Description
Dual-Flush, Round Bowl, Standard Height,
2-Piece Toilet (One Per Household)American Standard H2Option
Manufacturer
American Standard
Model Name
H2Option
GPF
.92/1.28
Color
White
   
Description
Elongated Bowl, Standard Height, 2-Piece ToiletAmerican Standard Cadet 3
Manufacturer
American Standard
Model Name
Cadet 3
GPF
1.28
Color
White
   
Description
Round Bowl, Standard Height, 2-Piece ToiletAmerican Standard Cadet 3
Manufacturer
American Standard
Model Name
Cadet 3
GPF
1.28
Color
White
   
Description
Round Bowl, Chair Height, 2-Piece ToiletAmerican Standard Cadet 3
Manufacturer
American Standard
Model Name
Cadet 3
GPF
1.28
Color
White
   
Description
Commercial, Elongated Bowl, High Top, 1-Piece,
Flush Valve ToiletAmerican Standard Madera FloWise
Manufacturer
American Standard
Model Name
Madera FloWise
GPF
1.1
Color
White
   
  Replacement Toilet # 2
   *Select Replacement Toilet 
Description
Dual-Flush, Round Bowl, Standard Height,
2-Piece Toilet (One Per Household)American Standard H2Option
Manufacturer
American Standard
Model Name
H2Option
GPF
.92/1.28
Color
White
   
Description
Elongated Bowl, Standard Height, 2-Piece ToiletAmerican Standard Cadet 3
Manufacturer
American Standard
Model Name
Cadet 3
GPF
1.28
Color
White
   
Description
Round Bowl, Standard Height, 2-Piece ToiletAmerican Standard Cadet 3
Manufacturer
American Standard
Model Name
Cadet 3
GPF
1.28
Color
White
   
Description
Round Bowl, Chair Height, 2-Piece ToiletAmerican Standard Cadet 3
Manufacturer
American Standard
Model Name
Cadet 3
GPF
1.28
Color
White
   
Description
Commercial, Elongated Bowl, High Top, 1-Piece,
Flush Valve ToiletAmerican Standard Madera FloWise
Manufacturer
American Standard
Model Name
Madera FloWise
GPF
1.1
Color
White
   
  Replacement Toilet # 3
   *Select Replacement Toilet 
Description
Dual-Flush, Round Bowl, Standard Height,
2-Piece Toilet (One Per Household)American Standard H2Option
Manufacturer
American Standard
Model Name
H2Option
GPF
.92/1.28
Color
White
   
Description
Elongated Bowl, Standard Height, 2-Piece ToiletAmerican Standard Cadet 3
Manufacturer
American Standard
Model Name
Cadet 3
GPF
1.28
Color
White
   
Description
Round Bowl, Standard Height, 2-Piece ToiletAmerican Standard Cadet 3
Manufacturer
American Standard
Model Name
Cadet 3
GPF
1.28
Color
White
   
Description
Round Bowl, Chair Height, 2-Piece ToiletAmerican Standard Cadet 3
Manufacturer
American Standard
Model Name
Cadet 3
GPF
1.28
Color
White
   
Description
Commercial, Elongated Bowl, High Top, 1-Piece,
Flush Valve ToiletAmerican Standard Madera FloWise
Manufacturer
American Standard
Model Name
Madera FloWise
GPF
1.1
Color
White
   
  Replacement Toilet # 4
   *Select Replacement Toilet 
Description
Dual-Flush, Round Bowl, Standard Height,
2-Piece Toilet (One Per Household)American Standard H2Option
Manufacturer
American Standard
Model Name
H2Option
GPF
.92/1.28
Color
White
   
Description
Elongated Bowl, Standard Height, 2-Piece ToiletAmerican Standard Cadet 3
Manufacturer
American Standard
Model Name
Cadet 3
GPF
1.28
Color
White
   
Description
Round Bowl, Standard Height, 2-Piece ToiletAmerican Standard Cadet 3
Manufacturer
American Standard
Model Name
Cadet 3
GPF
1.28
Color
White
   
Description
Round Bowl, Chair Height, 2-Piece ToiletAmerican Standard Cadet 3
Manufacturer
American Standard
Model Name
Cadet 3
GPF
1.28
Color
White
   
Description
Commercial, Elongated Bowl, High Top, 1-Piece,
Flush Valve ToiletAmerican Standard Madera FloWise
Manufacturer
American Standard
Model Name
Madera FloWise
GPF
1.1
Color
White
   
 
*Select Replacement
 Showerhead(s):
  Replacement Showerhead # 1
   *Select Replacement Showerhead 
Description
5-Spray, 3.38 in., Fixed ShowerheadDelta - Nickel
Manufacturer
Delta
GPM
2.0
Color
Nickel
   
Description
5-Spray, 3.38 in., Fixed ShowerheadDelta - Chrome
Manufacturer
Delta
GPM
2.0
Color
Chrome
   
  Replacement Showerhead # 2
   *Select Replacement Showerhead 
Description
5-Spray, 3.38 in., Fixed ShowerheadDelta - Nickel
Manufacturer
Delta
GPM
2.0
Color
Nickel
   
Description
5-Spray, 3.38 in., Fixed ShowerheadDelta - Chrome
Manufacturer
Delta
GPM
2.0
Color
Chrome
   
  Replacement Showerhead # 3
   *Select Replacement Showerhead 
Description
5-Spray, 3.38 in., Fixed ShowerheadDelta - Nickel
Manufacturer
Delta
GPM
2.0
Color
Nickel
   
Description
5-Spray, 3.38 in., Fixed ShowerheadDelta - Chrome
Manufacturer
Delta
GPM
2.0
Color
Chrome
   
 
*Select Replacement
 Faucet Aerator(s):
  Replacement Faucet Aerator # 1
   *Select Replacement Faucet Aerator 
Description
Low-flow Faucet AeratorPerlator - Nickel
Manufacturer
Perlator
GPM
1.5
Color
Nickel
   
Description
Low-flow Faucet AeratorPerlator - Chrome
Manufacturer
Perlator
GPM
1.5
Color
Chrome
   
  Replacement Faucet Aerator # 2
   *Select Replacement Faucet Aerator 
Description
Low-flow Faucet AeratorPerlator - Nickel
Manufacturer
Perlator
GPM
1.5
Color
Nickel
   
Description
Low-flow Faucet AeratorPerlator - Chrome
Manufacturer
Perlator
GPM
1.5
Color
Chrome
   
  Replacement Faucet Aerator # 3
   *Select Replacement Faucet Aerator 
Description
Low-flow Faucet AeratorPerlator - Nickel
Manufacturer
Perlator
GPM
1.5
Color
Nickel
   
Description
Low-flow Faucet AeratorPerlator - Chrome
Manufacturer
Perlator
GPM
1.5
Color
Chrome
   
 
 Comments (Optional):
*Replacement Fixture Program Terms
 This box must be checked
 
By checking this box and submitting this form, I agree to keep the water-efficient
fixtures in place at the address listed above. If a fixture requires replacement, I
will install a fixture with a water efficiency rating equal to or greater than the
fixture that was installed.
 
I understand that when my application is processed, an Aquarion representative
may contact me to verify the information that was submitted.
 
I understand that the replacement fixtures were selected on the basis of water
efficiency only. Aquarion does not endorse specific brands or products, nor does
it guarantee materials.
 
I certify that the information on this application is true and correct to the best of
my knowledge.
 
I understand a work agreement must be completed and signed prior to fixture
installations.
 
I acknowledge that all work completed must be done in accordance with the
Plumbing Code.
 
Upon submission of this application, you will be contacted within forty-five days.
If your application is approved, a licensed plumber, selected by Aquarion, will
schedule your fixture installation date and confirm replacement fixture choices.
 
By applying for this program, homeowner agrees to hold Aquarion Water Company
harmless from any damages and liability associated with participation in this program.
 
Note: * Indicates required fields