6100-10 Promotional Partner Checklist

OMB Control Number 2040-XXXX

Approval Expires XX/XX/XXXX

For Utilities, Communities, and Organizations

Using the WaterSense Brand/Logo

P romotional Partner Checklist

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

Section I: Marketing Contact Information

Organization Name¹: ____________________________________________________________

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

Name: ________________________________Telephone:______________________________

Fax: ________________________________E-mail: _________________________________

Number of residential customers in service area²: ______________________________________

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)

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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.)

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

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3) As the program evolves, WaterSense will continue to create tools and materials for partners. We are interested in your feedback; please let us know how we can assist your efforts to promote water efficiency and WaterSense products and programs.

□ 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 <[email protected]>. Upon completion, please fax this form to WaterSense at (703) 841-1440.

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.

1 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.

2 For utilities only

2

E PA Form Number 6100-10