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Free Toilets for Low-Income Homeowners

This program provides low income renters and homeowners with water saving toilets.

4 of 7 Tell Us About Yourself

Based on your answers, you may be able to receive a free toilet.
We will now ask you for contact information, proof of eligibility, and other basic information.

Please enter your first and last name

Please enter your current address.

(US and Canada only)

Please enter your email address

Date of birth

Please enter your date of birth in the format mm/dd/yyyy

Are you a homeowner or a renter?

Alternate contact  

Is there someone else we may contact in the case that we cannot reach you to schedule installation?

Personal information entered on this form is subject to Washington Public Records Act, and may be subject to disclosure to a third-party requestor. At the City of Seattle, we are committed to protecting your privacy and will ensure that any disclosures are done according to law. To learn more about how this information is managed please see our Privacy Statement: http://www.seattle.gov/tech/initiatives/privacy

Some answers on this page need to be fixed

This page of your application either has some errors or some fields were left blank. If you continue to the previous page, none of the information entered on this page will be saved until the errors are corrected.