2. 
4. Please complete this form to apply to the Certified Blue Commercial Water Conservation Program.
   If you are applying for several locations. You must fill out a separate form for each location.
5. The Water Conservation Office will contact you within 5 business days of your submittal.
6. Today's Date*
8. First Name*
9. Last Name*
11. Name of Business
13. Business Address 1*
15. Business Address 2
17. City
18. State
19. Zip*
21. Primary Phone Number *
23. Alternative Phone Number
25. E-mail*
26. Business Website
28. Check all that apply*

    1. I have read the Certified Blue website.
    2. I am authorized to complete this form by owner/management of store.
    3. My store is prepared to implement water-saving strategies.
    4. This store is prepared to implement public education strategies.
    5. This store is up to date with the Stormwater Utility fee.
    6. This store has had no Stormwater Violations in the last 12 months.
29. For more information on Stormwater
    Athens-Clarke County Stormwater Program
31. What is your role at this business?

    1. Owner
    2. Manager
    3. Employee
    4. Other
32. Business's Account Number on Water Bill*
34. Thank you for your application!
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit Submit and Print

* indicates a required field