For Utilities, Communities, and Organizations 

Using the WaterSense Brand/Logo

Promotional Partner Checklist

Please complete and submit with a signed WaterSense promotional
partnership agreement. 

Section I: Marketing Contact Information

Organization Name:
____________________________________________________________

Main Promotional or Marketing Contact (for questions regarding this
plan)

Name:
________________________________Telephone:______________________________

Fax:	________________________________E-mail:
_________________________________

Number of residential customers in service area:
______________________________________

Section II: WaterSense Branding and Logo Use

As we build a national brand for water efficiency, WaterSense invites
its promotional partners to use the WaterSense logo, messages, and
materials in outreach and educational activities promoting
water-efficient products and practices, consistent with the WaterSense
guidelines. In which of the following areas do you plan to use the
WaterSense logo and/or label for promotional purposes?

□	Consumer education and outreach 

□	Community events and/or retail promotions

□	Web site

□	Rebate program that refers to the WaterSense label (please describe
below)

□	Bill stuffers, brochures, or other constituent communications

□	Advertising/PSAs (please specify which and where they will be
placed)

□	Turnkey outreach campaign with WaterSense brand (please describe
below)

□	Schools, institutions, or commercial outreach

□	Other (please describe in detail below)

________________________________________________________________________
____________

________________________________________________________________________
____________

________________________________________________________________________
____________

________________________________________________________________________
____________

Section III: Promotional Efforts and Plans

WaterSense would like to know more about your current and planned water
efficiency outreach efforts to assess how we can best serve our
partners. Please include activities such as education campaigns,
rebates, performance contracting, irrigation audits, or other programs
that focus on specific indoor or outdoor water use.

1) What activities or incentive programs do you currently conduct to
educate consumers/businesses about water efficiency? (If you have Web
page for your water efficiency program, please provide the URL.)

________________________________________________________________________
____________

________________________________________________________________________
____________

________________________________________________________________________
____________

________________________________________________________________________
____________

2) What new activities or incentive programs will you consider
conducting to educate consumers, organizations, or businesses about
WaterSense? 

________________________________________________________________________
____________

________________________________________________________________________
____________

________________________________________________________________________
____________

________________________________________________________________________
____________

3) As the program evolves,
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□	Template promotional tools, such as:
___________________________________

□	Assistance in technical areas (e.g., performance contracting)

□	Case studies of successful promotional efforts

□	Partnerships with government, retail, or nonprofit programs

□	Other: ___________________________________________________________

For questions regarding this form, please call (866) WTR-SENSE / (866)
987-7367 or e-mail <  HYPERLINK "mailto:watersense@erg.com" 
watersense@erg.com >. Upon completion, please fax this form to
WaterSense at (703) 841-1440.

 Please use the same organization name used on your partnership
agreement. If you do not yet have a partnership agreement, please
contact us to complete one.

 For utilities only

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ᄀ 2040-XXXX

Approval Expires XX/XX/XXXX

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EPA Form Number 6100-10

The public reporting and recordkeeping burden for this collection of
information is estimated to average 13 hours per response. Send comments
on the Agency's need for this information, the accuracy of the provided
burden estimates, and any suggested methods for minimizing respondent
burden, including through the use of automated collection techniques to
the Director, Collection Strategies Division, U.S. Environmental
Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C.
20460. Include the OMB control number in any correspondence. Do not send
the completed promotional plan checklist to this address.

