City of Manchester, NH Official Website

Service Line Protection Plan On-Line Enrollment Form

Manchester Water Works
Service Line Protection Plan
On-Line Enrollment Form

Please bill me in four equal installments on my monthly water bills.
I understand coverage will not begin until the date of my next bill.

Name:
Email:
Daytime Phone:
555-555-5555
Address of covered property:
City:
State:
Zip:
Placeholder's Mailing Address:
(if different than covered property)
 

By clicking the “submit” button below, you are verifying your enrollment, and acceptance of the Terms and Conditions of the plan. Please keep a copy of this form, and refer to the Service Line Protection Plan page as your description of plan coverage.

 
 

Questions? Call us today at (603) 624-6494

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