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2. You can receive a $40 rebate for a new compost bin or a $35 rebate for a home-built compost bin.

4. First Name*
5. Last Name*
7. Address*
9. Phone Number*
10. Email Address*
12. Mailing address, if different from above:
14. City
15. State
16. Zip Code
18. How did you hear about this program?*
20. If you have purchased your composter, please provide the brand and model number:
22. If you built your own composter, please provide a materials list:
24. Capacity of your compost bin:*
25. Date installed:*
26. Cost*
28. photo of compost bin installed on your property*
29. upload photos/receipts
30. upload photos/receipts
31. upload photos/receipts
33. Compost Workshop Class (if attended)
34. Date
    Date
35. Location
36. Instructor
38. Applicant Agreement I certify that I live within Roeland Park, KS. I understand that the City of Roeland Park, KS 1) does not guarantee the performance of the bin, and 2) does not warranty any bin to be free of defects. The undersigned further agrees to defend, indemnify and hold harmless the City of Roeland Park, KS including their employees, from and against any and all loss, damage, expense, claims suits and liability, including attorney fees arising out of or in any way connected with the bin. Applicant has read, understands and agrees to the terms and conditions listed on the Compost Bin Rebate Program application. The City of Roeland Park, KS reserves the right to change the terms of the incentive offer at any time. I have read, understand, and agree to the terms and conditions of this rebate program.
40. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
42. Electronic Signature*
Leave This Blank:


44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit

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