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2. In order to qualify for the plan, the customer must meet the following requirements:
4. 1. In the most recent twelve (12) months, the Customer must have occupied the service address location, been continuously connected to the Town’s water system, and had a satisfactory payment history during such period.*

   1. Yes
   2. No
5. 2. All bills, including the current bill for water utility service, must have been paid so that no amounts are due on the account.*

   1. Yes
   2. No
7. 3. All payments made under the AMPP, must be made by automatic bank draft.*

   1. Agree
   2. Disagree
8. 4. A Customer will not be eligible to enroll if the history reflects any NSF checks, late payments (penalties) or cut-off’s within a rolling 18 months.

   1. Agree
   2. Disagree
10. 5. If previously enrolled in AMPP and exit the program, you are not qualified to re-enroll in the program for a period of 18 months.*

    1. Agree
    2. Disagree
12. Fill out the form below to begin the enrollment process.
    You may cancel the AMPP program at any time. The plan will remain in force until terminated. After termination, your next regular bill will then be a ‘settlement’ bill and will include all unpaid and current charges. To cancel the program select the unenroll option and click on the submit button.
14. First Name*
15. Last Name*
17. Street Number*
18. Street Name*
19. Street Type
21. City
22. State
23. Zip
25. Phone Number - Primary*
26. Phone Number - Secondary
28. Email*
30. I understand that I have not actually enrolled in the program yet. *

    1. Agree
    2. Disagree

    Once this form is submitted, a Town representative will contact you about your interest and the next steps required.
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field