Free Conservation Kit Request Form
Your Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date
Account Number
*
Service Address
*
Service Address
Service Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Your Email
*
example@example.com
Sign me up for the Latest News!
Number of people living in the residence
*
What type of landscaping do you have?
*
Mostly grass
Mostly desert landscape
Mix of both grass and desert landscaping
How did you hear about this program?
*
Newsletter
Bill insert
Website
Social media
Email
Digital ad
Family/friend
Community event
Other
Conservation kits can be picked up between 8 a.m. and 5 p.m. Monday through Friday at 1200 S. Gene Autry Trail, Palm Springs, 92263
Please provide the date and time you plan to pick up your conservation kit.
Pickup Date and Time
*
/
Month
/
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
CAPTCHA
*
SUBMIT
Should be Empty: