Free Toilets for Low-Income Homeowners

Does your home receive water provided by Seattle Public Utilities? *

Are you currently enrolled in the Utility Discount Program? *

Do you have a toilet older than 2004 that you want to replace? If so, how many? *

How many people are in your household, including yourself? *

Monthly household income *

Please enter your first and last name *

Please enter your current address. *

Please enter your 10 digit phone number. *

Email address *

Date of birth *

Are you a homeowner or a renter? *

Alternate contact   *

Alternate contact name *

Alternate contact phone *

Alternate contact email

What is your race? *

Are you of Hispanic, Latina/Latino/Latinx or Spanish origin? *

What is your preferred language? *