Aqua | Forms

Forms You May Need

Check out the following forms you may need as a new or current Aqua customer. If you need assistance, please reach out to Aqua Customer Service via the form on the Contact Us page.

Aqua Forms

A Medical Certificate is written confirmation from a customer’s physician or nurse practitioner that the customer, or someone else living at the property, has a medical condition that would be aggravated if Aqua shut off the water (usually for non-payment). Once received by Aqua, a valid medical certificate gives the customer 30 days to pay the bill or to make payment arrangements.

Send your medical certificate...

By mail:
ACO
Attention: Collections Department
762 W. Lancaster Avenue
Bryn Mawr, PA 19010

By fax: 866.780.8301

By email: nationalcollections@aquawater.com

Download Aqua's Medical Certificate here.

Download Aqua Ohio's Medical Certificate Form here.

Download Aqua Illinois' Medical Certificate Form here.

PA Medical Certificate Guidance

PUC Medical Certificate

The below application is for new customers needing to transfer existing services into their name. If you are needing to inquire about a new water/sewer tap, please reach out to customer service at 877-987-2782.

TX - Customer Service Agreement
TX - Customer Service Agreement (Spanish)
Click here to complete the TX application on-line via DocuSign
Haga clic aquí para completar su solicitud de TX en línea a través de DocuSign

Aqua Illinois Residential Water, Sewer Service Application Form

Download Here

Forms You May Need

Aqua Forms

Medical Certificate Form

Texas Service Application

Aqua Leak Adjustment Forms

Illinois Residential Water, Sewer Service Form

Revert to Landlord Permission Form

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