New Services Inquiry

Thank you for applying to Aquarion Water Company for water service. Please fill in the pertinent information.

Upon submitting this form you will receive an email confirmation and your request will be reviewed.

  Property Address
    *Street Number 
    *Street Name 
  Requestor's Information
    *Requestor's First / Last Name
    *Call Back Number
 -   -   Ext.   
    *Email Address
(We will never disclose your email address)
    *Relationship to Property
  Property Owner's Information
    *Property Owner's Name
    *Mailing Address
 -   -   Ext.   
(We will never disclose your email address)
  Intended Use Of This Property
 *(Please check all applicable boxes)
    Multi-Family /
  Public Authority   
  Combination Residential / Commercial
  What Are Your Needs?
 *(Please check all applicable boxes)
  Domestic Water Supply to Building
  Lawn Irrigation
  Fire Service / Sprinkler   
  Building Information
    *Does the building have frontage
 on a State Road? (i.e., State Route
 25 aka Main Street, Monroe)
Yes   No    I don’t know
    *Nearest cross street
    *Distance from street to the
    *Number of bedrooms
    *Required Gallons Per Minute
 (GPM), if known
 GPM       Unknown   
    *Building length
    *Building width
    *Number of floors
    *Number of units
    *Is there an existing building?
Yes   No
    *Is the building being
Yes   No
  Well Information
    *Is this property currently on
 a well?
Yes   No
    *Has the well failed?
Yes   No
    *Do you plan to keep the well?
Yes   No   I don’t know
  Attachments Including Maps, Pictures, Drawings and Sketches (Optional)
  Comments (Optional)
Note: * Indicates required fields