Tenant Application for Water Utility Services

In the event that you do not move into the property or the date is changed, please notify Aquarion immediately in order to avoid billing errors.

Note: If you prefer to download and fax the form back to us rather than complete it online, please use fax number 203-445-7308. For clarity purposes, please type the downloaded form rather than handwrite it.

If you have any questions or difficulty completing the form, please contact us at
203-445-7310 or 1-800-732-9678.

Date Service is Requested:
(From date must be within last 90 days)
 
     
  *From:
 /   /     (MM/DD/YYYY)  
 
     
  *To:
 /   /     (MM/DD/YYYY)  
 
FebMarch 2019Apr
SunMonTueWedThuFriSat
242526272812
3456789
10111213141516
17181920212223
24252627282930
31123456
 
*Period of Lease:
    (minimum 6 months)
 
6 months   12 months   
Other
    *Other:
   
  
*Tenant Name(s):
   *1. First / Last Name 
   
   *2. First / Last Name 
   
 
Service Information:
 
    *Service Address 
    *City
    *State
    *Zip
 -   
   
  
Billing Information  
    *Billing Address
     
    *City
    *State
    *Zip
 -   
    *Home Phone or Cell Phone
 -   -   Ext.   
(A valid phone number must be entered. We do not sell or utilitize your
  number for anything other than official Aquarion business, such as a
  “Code Red” in the event of water outages or other emergencies. If you would
  prefer to not receive these calls, please call our call center or email us at
  CS@aquarionwater.com.
)
     Email Address:
(We will never disclose your email address)
*Landlord's Name:
  Mailing Address:
    *Address
     
    *City
    *State
    *Zip
 -   
    *Phone
 -   -   Ext.   
(A valid phone number must be entered. We do not sell or utilitize your
  number for anything other than official Aquarion business, such as a
  “Code Red” in the event of water outages or other emergencies. If you would
  prefer to not receive these calls, please call our call center or email us at
  CS@aquarionwater.com.
)
     Cell Phone
 -   -   
     Email:
(We will never disclose your email address)
*Have you ever had service with
 us before?
Yes   No
(If you selected yes, please list all addresses which you have previously had service.)
*Previous Addresses:
  Address # 1
   *Address 
   *City 
   *State 
   *Zip 
 -  
  Address # 2
   *Address 
   *City 
   *State 
   *Zip 
 -  
  Address # 3
   *Address 
   *City 
   *State 
   *Zip 
 -  
  Address # 4
   *Address 
   *City 
   *State 
   *Zip 
 -  
 
 Attachments (Optional):
 
 
 Comments (Optional):
 
*IMPORTANT
 This box must be checked
 
By checking this box and submitting this form, I agree that I am responsible for the water
utility bill from the date service is requested and that I understand that a security deposit
will be applied on my first bill (see fees below). When an account with a deposit has
maintained an excellent credit rating (no late notices or fees) for one year, the deposit
plus interest will be credited to the account at that time; or upon final termination of the
account with Aquarion.
 
Security Deposit Fees
 
Commercial Tenant Deposits - Commercial tenants must pay an initial deposit of $100
which will be reviewed for adequacy after the first bill. If the average billings over 90 days
exceed $100, you may receive a request for an additional deposit.
 
Residential Single-Family Tenant Deposits - Residential tenants must provide a
security deposit of $100.
 
 
Note: * Indicates required fields